Kaori Nishiwaki ^A1, Tetsuya Tsuji ^A2, Meigen Liu ^A1, Kimitaka Hase ^A1, Naofumi Tanaka ^A1, Toshiyuki Fujiwara ^A1
A1 From the Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo
^A2 Department of Rehabilitation Medicine, Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan
DOI: 10.1080/16501970510026999

Objective: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke. Design: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test. Patients: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan. Methods: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study. Results: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61–83%) and a specificity of 67% (CI: 55–79%) as a predictor of aspiration (p <0. 05). Conclusion: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration.