Clinical Assessment of Swallowing and Prediction of Dysphagia Severity

TLDR

Dysphagia with aspiration is common after acute stroke, yet noninvasive clinical screening tools to identify patients at risk are scarce. The study aimed to evaluate whether clinical examination risk factors could approximate videofluoroscopic swallow study results in determining dysphagia severity. Six clinical signs—dysphonia, dysarthria, abnormal volitional cough, abnormal gag reflex, cough after swallow, and voice change after swallow—were assessed in 59 consecutive stroke patients within five days of admission, and VSS was scored on a 0‑to‑4 severity scale. Patients exhibiting at least two of these six signs reliably differentiated moderate‑to‑severe dysphagia from mild or normal swallowing, indicating the screening tool offers objective criteria for selecting patients who need VSS.

Abstract

Dysphagia with aspiration is prevalent in acute stroke; however, noninvasive clinical screening assessments to identify patients at risk of developing aspiration are limited. This study was undertaken to determine whether risk factors detected in the clinical examination approximated the videofluoroscopic swallow study (VSS) in identification of dysphagia severity. Six clinical features—dysphonia, dysarthria, abnormal volitional cough, abnormal gag reflex, cough after swallow, and voice change after swallow—were assessed by means of an oropharyngeal evaluation and a clinical swallowing examination. Clinical assessments and VSS were completed on consecutive stroke patients ( n =59) within 5 days of hospital admission. The VSS was scored on a scale of 0 to 4 (0=normal, 1=mild, 2=moderate, 3=moderate-severe, 4=severe dysphagia). Results showed that the presence of at least 2 of the 6 clinical features consistently distinguished patients with moderate to severe dysphagia from patients with mild dysphagia/normal swallowing. These data demonstrate that this clinical dysphagia screening tool can provide objective criteria for the need for VSS in acute stroke patients.