Clinical predictors of dysphagia and aspiration risk: Outcome measures in acute stroke patients

Objective: To use an established dysphagia clinical screening system to evaluate outcomes in acute stroke patients. Design: Case-control study. Setting: Tertiary care center. Participants: Acute stroke patients (n = 56) consecutively referred to a speech pathology service. Main Outcome Measures: Outcomes (ie, pneumonia, dietary status at discharge) in patients who were referred for a videofluoroscopic swallow study (VSS) based on results of a previously validated clinical screening system were compared with outcomes in patients who were not referred for VSS based on the clinical evaluation. Results: Thirty-eight of 56 patients (68%) presented with 2 or more clinical predictors of moderate to severe dysphagia and were further evaluated with VSS, whereas 18 patients (32%) had fewer than 2 clinical features and were not evaluated radiographically. Based on patient outcomes and VSS results, identification of at least 2 clinical predictors significantly distinguished patients with moderate to severe dysphagia from patients with mild dysphagia or normal swallowing. None of the patients in either group developed pneumonia while following recommendations of the clinical or dynamic swallowing evaluation, and 93% of the patients returned to a regular diet. Conclusions: These data demonstrate that clinical use of this screening system can objectively identify acute stroke patients who warrant further diagnostic studies and can safely determine which patients need no further deglutitive evaluation.