Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test

Objective: To assess the sensitivity and specificity of a simple swallowing provocation test (SPT) and a water swallowing test (WST) in detecting aspiration pneumonia in elderly patients with stroke. Design: Retrospective comparative study involving a simple 2-step SPT and WST on all subjects. Participants: Twenty-six stroke patients with aspiration pneumonia (mean age, 72.1 +/- 4.1yr) and 26 age-matched stroke patients without aspiration pneumonia (mean age, 69.4 +/- 3.9yr). Interventions: The normal response to SPT was determined by inducing swallowing reflex within 3 seconds after water injection into the suprapharynx. In WST, subjects drank quantities of 10 and 30mL of water from a cup within 10 seconds. The subject who drank water without interruption-without evidence of aspiration-was determined as normal. Results: The sensitivity and specificity of first-step SPT for the detection of aspiration pneumonia were 100% and 83.8%, respectively. Those of the second-step SPT were 76.4% and 100%, respectively. The sensitivity and specificity of first-step WST using 10mL of water for the detection of aspiration pneumonia were 71.4% and 70.8%, respectively. Those of the second-step WST using 30mL of water were 72% and 70.3%, respectively. Conclusion: SPT is more useful than WST in differentiating patients predisposed to aspiration.