Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses

Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating. Dysphagia affects between one and two thirds of patients with acute stroke, with the potential for life-threatening airway obstruction, aspiration pneumonia and malnutrition. Whilst associated with increased impairment, dysphagia may present in isolation or accompanied by minimal disability; universal screening of swallowing function is recommended. This study describes the process undertaken to review the evidence for dysphagia screening methods in patients with acute stroke. It also identifies, implements and establishes sensitivity and specificity of a screening tool (the Standardized Swallowing Assessment, SSA) for use by nurses. Not all ward staff had completed training to use the SSA by conclusion of the patient audit. Nonetheless 123 out of 165 assessable patients (74.5%) had their swallow function screened, 64 by SSA (52%). Based on 68 completed screening episodes by independently competent nurses, a comparison with summative clinical judgement of swallow function revealed a sensitivity of 0.97 and specificity of 0.9 for detection of dysphagia, with positive and negative predictive values of 0.92 and 0.96. This was significantly better than gag reflex performance, supporting the use of the SSA by competent ward nurses.