CAN BEDSIDE ASSESSMENT RELIABLY EXCLUDE ASPIRATION FOLLOWING ACUTE STROKE

Objective: to investigate the ability of a bedside swallowing assessme nt to reliably exclude aspiration following acute stroke. Subjects: co nsecutive patients admitted within 24 h of stroke onset to two hospita ls. Methods: a prospective study. Where possible, all patients had the ir ability to swallow assessed on the day of admission by both a docto r and a speech and language therapist using a standardized proforma, A videofluoroscopy examination was conducted within 3 days of admission . Results: 94 patients underwent videofluoroscopy; 20 (21%) were seen to be aspirating, although this was not detected at the bedside in 10, In 18 (22%) of the patients the speech and language therapist conside red the swallow to be unsafe, In the medical assessment, 39 patients ( 41%) had an unsafe swallow. Bedside assessment by a speech and languag e therapist gave a sensitivity of 47%, a specificity of 86%, positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 85% for the presence of aspiration. Multiple logistic regression was used to identify the optimum elements of the bedside assessments for p redicting the presence of aspiration. A weak voluntary cough and any a lteration in conscious level gave a sensitivity of 75%, specificity of 72%, PPV of 41% and NPV of 91% for aspiration. Conclusion: bedside as sessment of swallowing lacks the necessary sensitivity to be used as a screening instrument in acute stroke, but there are concerns about th e use of videofluoroscopy as a gold standard. The relative importance of aspiration and bedside assessment in predicting complications and o utcome needs to be studied.