The Rapid Aspiration Screening in Suspected Stroke Part 1: Development and Validation

Publication date: Available online 23 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Stephanie K. Daniels, Shweta Pathak, John C. Rosenbek, Robert O. Morgan, Jane A. Anderson
ObjectivesTo develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke.DesignValidity study comparing evidence-based swallowing screening items with videofluoroscopic swallowing study (VFSS).SettingsThe study was completed in a certified primary stroke center in a major metropolitan medical facility.ParticipantsConsecutive patients (N=250) admitted with suspected stroke.InterventionsPatients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening.Main Outcome MeasureValidity relative to identifying VFSS determined aspiration for each screening item and for various combinations of items.ResultsAspiration was identified in 29 of the 250 participants. Logistic regression revealed age (p=0.012), dysarthria (p=0.001), abnormal volitional cough (p=0.030), and signs related to trial water swallow (p=0.021) to be significantly associated with aspiration. Validity was then determined based on the best combination of significant items for predicting aspiration. Results revealed that age >70, or dysarthria, or signs related to trial water swallow (i.e., cough, throat clear, wet vocal quality, and inability to continuously swallow 90ml water) yielded 93% sensitivity and 98% negative predictive value.ConclusionsThe final validated tool, Rapid Aspiration Screening for Suspected Stroke (RAS³), is a valid nurse-administered tool to detect risk of aspiration in patients presenting with suspected stroke.



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