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Spotlight on a practical tool based on research

Screening for dysphagia and risk of aspiration in stroke patients

By Amy Ryan, M.S., CCC-SLP and Dana Read, M.S., CCC-SLP; CBIS-T

As speech pathologists and leaders in the stroke rehabilitation acute care setting, we know that a reliable swallow-screening tool is essential in treating patients at risk for dysphagia. Early detection of dysphagia and the risk of aspiration are critical in improving swallowing function and maintaining health and safety during a patient’s hospital course. This is especially important with stroke patients, a population in which oropharyngeal dysphagia occurs in 42 percent to 67 percent of patients within the first 3 days.

We also know that hospitals using mandatory and formal dysphagia screening tools have lower rates of aspiration pneumonia than those that do not. About 44 percent of speech-language pathologists in the U.S. use internally developed screening tools. At SSM Health Network, we had been using a screener called the Nursing Swallow Screener since 2010.

However, we began receiving internal feedback that nurses did not like the tool. They were reporting concerns that the questions caused confusion with the way it appeared in the electronic health record.

In pursuit of a new tool, better outcomes, and cost-effectiveness for patients, we initiated a project to evaluate swallow screener tools for patients admitted with the diagnosis of stroke. 

Evaluating the DePaul Hospital Swallow Screener tool

At the time of the project, several screening tools were proposed, but many of them had not been evaluated for validity and reliability. Therefore, we developed and validated the DePaul Hospital Swallow Screener (DHSS) tool and conducted a study to validate it. 

The DHSS includes non-swallow and swallow items, which is best practice for swallow screens. All patients admitted under a standard stroke protocol are screened by the nursing staff using the DHSS. Following the DHSS swallow screening, the patients are objectively evaluated by a speech-language pathologist using the Mann Assessment of Swallowing Ability (MASA).

We asked six subject matter experts, which included speech-language pathologists, physicians, and nursing administration, to evaluate the content validity of eight non-swallow items, ranking them in importance. The non-swallow items ranked most important were evaluated by the experts with an overall content validity index (average) score of 92 percent, indicating very high validity. Compared to the MASA, the DHSS has moderate agreement, high specificity with average sensitivity, and reliable predictive values. 

In summary, we found the DHSS to be a comprehensive bedside screening tool for dysphagia in stroke patients. Its content has been validated among experts in the field. The tool is accessible and easily administered with minimal training required. As we look into the future, further studies are needed to evaluate the use of the DHSS in more diverse patient populations.

Editor’s Note: DePaul Hospital is part of the SSM Health Network. Amy Ryan and Dana Read are presenting a live webinar on August 22 to teach other acute-care providers how to develop and study the validity of swallow screening tools. Visit www.cvent.com/d/2gqnrv

8/15/2018
(Medical Rehabilitation)


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