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Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta?analysis

Benfield, Jacqueline K.; Everton, Lisa F.; Bath, Philip M.; England, Timothy J.

Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta?analysis Thumbnail


Authors

Jacqueline K. Benfield

Lisa F. Everton

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine



Abstract

Introduction

Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost‐effectiveness of these tests.

Methods

Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta‐analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS‐2.

Results

Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta‐analysis, demonstrating high sensitivity; 96% (95% CI 0.90–0.99), but low specificity, 65% (95% CI 0.47–0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor.

Conclusions

There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost‐effectiveness in acute stroke.

Relevance to Clinical Practice

Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost‐effectiveness.

Citation

Benfield, J. K., Everton, L. F., Bath, P. M., & England, T. J. (2020). Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta?analysis. Journal of Clinical Nursing, 29(9-10), 1527-1538. https://doi.org/10.1111/jocn.15192

Journal Article Type Article
Acceptance Date Jan 10, 2020
Online Publication Date Jan 22, 2020
Publication Date 2020-05
Deposit Date Feb 18, 2020
Publicly Available Date Mar 29, 2024
Journal Journal of Clinical Nursing
Print ISSN 0962-1067
Electronic ISSN 1365-2702
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 29
Issue 9-10
Pages 1527-1538
DOI https://doi.org/10.1111/jocn.15192
Keywords General Nursing; General Medicine
Public URL https://nottingham-repository.worktribe.com/output/3986383
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15192
Additional Information This is the peer reviewed version of the following article: Benfield, JK, Everton, LF, Bath, PM, England, TJ. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis. J Clin Nurs. 2020; 00: 1– 12, which has been published in final form at https://doi.org/10.1111/jocn.15192. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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