Purpose: The purpose of this literature review is to discuss the detrimental effects of aspiration in acute stroke patients, and determine which screening tools are the best at detecting dysphagia prior to aspiration.
Clinical Question: Which bedside dysphagia evaluation tools, if any, are effective at identifying the risk for aspiration?
Problem: Stroke affects nearly 795,000 people a year in the United States, and of those affected, approximately 130,000 die. There are numerous physical and psychological deficits that affect those who survive. One of the most common effects of a stroke is dysphagia, which occurs in roughly 50-80% of cases. Of those effected by dysphagia, studies show that between 22 and 25% aspirate. An increased risk for aspiration in stroke patients may result in an increased length of stay, increased mortality, and decreased overall outcome in patients.
Methods: A systematic literature review of research was conducted utilizing the databases of CINAHL, PubMed, and Cochrane. The population of interest included acute stroke patients with dysphagia. Keywords consisted of: stroke, dysphagia evaluation, swallow screen, and aspiration. The primary inclusion criteria were: acute stroke patients, acute care setting, articles written in English, published within the last five years, articles that have been peer reviewed, and randomized control trials or systematic reviews.
Results: The literature review elicited four research articles that met inclusion criteria and were selected for critical analysis. There was a large amount of evidence to support that aspiration is directly linked to an increased length of stay. The research identified that either no dysphagia screening or dysphagia tools not supported by research were linked to aspiration, which in turn caused an increased length of stay. Secondly, the evidence identified a strong association between aspiration and increased complications and increased mortality. The Barnes-Jewish Hospital Stroke Dysphagia Screen (BJHSDS) and the Toronto Bedside Swallowing Screening Test (TORBSST) were identified at being the most successful in recognizing dysphagia through comparison to fluoroscopy. Thus having the lowest rates and complication and mortality. A final conclusion of the literature was that early identification of dysphagia prevented aspiration and led to a prevention of decreased functional outcomes.
Conclusion: The BJHSDS and the TORBSST were identified to be 94% and 92% accurate at recognizing dysphagia. Aspiration is linked to increased length of stay, increased complications, increased mortality, and a decrease in functional outcomes. Early and accurate identification of dysphagia will work to prevent aspiration. It is recommended that organization employ dysphagia screens with proven high dysphagia identification in order to limit the incidence of aspiration.