Role of registered dietitians in dysphagia screening

Objective To examine the ability of registered dietitians to identify patie nts at risk for dysphagia and make appropriate diet/feeding recommendations in comparison with the speech-language pathologist, and to determine scree ning criteria for the registered dietitian to use for prediction of dysphag ia risk. Design The dietitian and speech-language pathologist performed dysphagia sc reening on subjects independently through questioning and/or mealtime obser vation to identify signs and symptoms of dysphagia. Presence of dysphagia r isk and diet/feeding recommendations were determined and results from the d ietitian and speech-language pathologist were compared. Subjects/setting Th irty-four patients admitted during a 2-month period to a neuroscience unit at an urban teaching hospital were analyzed prospectively. Statistical analyses performed kappa Statistics were used to assess agreeme nt between the dietitian and speech-language pathologist. A kappa level of less than 0.4 indicated weak agreement, 0.4 to 0.7 indicated moderate agree ment, and greater than 0.7 indicated strong agreement. Logistic regression methods were used to evaluate screening criteria as potential predictors of dysphagia risk. Results Moderate agreement (0.61) was found between the dietitian and speec h-language pathologist in determination of dysphagia risk. The dietitian pr edicted the ability of the patient to consume an oral diet with strong agre ement with the speech-language pathologist (1.0); various diet consistencie s with moderate agreement (0.61); and the need for liquid restrictions with strong agreement (1.0). The most significant screening variables for predi ction of dysphagia risk (P<.05) were age (P=.018), history of dysphagia (P= .042), difficulty swallowing solids (P=.0007), observed facial weakness (P< .0001), and a change in voice quality (P=.0007). Self-reported screening va riables significantly related to dysphagia risk included drooling of liquid s (P=.0009) and solids (P=.0080), facial weakness (P=.0006), change in voic e quality (P=.0010), and prolonged eating time (P=.0157). Applications/conclusions Dietitians can effectively identify patients with dysphagia. Screening for dysphagia can be implemented as part of standard n utrition assessments and may aid in decreasing dysphagia-related complicati ons.