Swallow screen associated with airway protection and dysphagia after acute stroke

Publication date: Available online 23 January 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Rachel W. Mulheren, Marlís González-Fernández

Abstract

Objective

The goal was to examine the outcomes of an existing swallow screen protocol in comparison to results from a formal videofluoroscopic protocol.

Design

Prospective cohort study.

Setting

Acute hospital.

Participants

48 patients after acute stroke.

Interventions

Not applicable.

Main outcome measures

The Johns Hopkins Hospital Brain Rescue Unit 3 oz. Swallow Screen was implemented by nursing staff upon admission. Videofluoroscopy was conducted within 72 hours of diagnostic neuroimaging and initial swallow screen. Predictive values of the bedside swallow screen (pass/fail) for clinical judgment of dysphagia on videofluoroscopy (presence/absence) were calculated. Overall impairment scores from the Modified Barium Swallowing Impairment Profile were analyzed with respect to swallow screen results.

Results

Thirteen participants failed the Swallow Screen, and 35 passed. Of the 35 patients who passed the swallow screen, 15 were clinically diagnosed with dysphagia on videofluoroscopy. Although pass/fail of the swallow screen was not a significant predictor of presence/absence of dysphagia, a logistic regression model including components of Laryngeal Elevation, Laryngeal Vestibule Closure, and Anterior Hyoid Excursion, and gender was statistically significant for swallow screen outcome.

Conclusion

The results of this study suggest that a swallow screen of aspiration risk can identify patients with the most need for videofluoroscopic evaluation and dysphagia management. Additionally, patients who fail a swallow screen are more likely to present with physiologic impairments related to airway protection on videofluoroscopy.

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