Early identification of dysphagia in inpatients on acute stroke wards has been recommended as best practice guidelines in many countries. However, several institutions fail to use formal dysphagia screening protocols and rely on informal detection by nurses and doctors. This paper examines the accuracy of informal detection within the first 48 hours of admission to an acute stroke facility in Canada. The authors reviewed the medical records of 221 patients admitted to the acute stroke ward over a five-year period. They examined the first entry notations made by nurses and doctors (n=170) to establish impressions on the absence or presence of dysphagia. Notations involving a sign such as refusal to eat, coughing or choking, a specific symptom or direct reports from patient or caregiver were scored positive for dysphagia. Notations suggesting no signs of dysphagia, or direct observations of “patient eating without difficulty” were scored as negative (dysphagia absent). Formal assessment by the speech and language therapist served as the reference standard to determine sensitivity and specificity.
They found accuracy of informal detection to be low with sensitivity at 36.7% [95% CI 25.9, 50.1], but specificity was high at 94.2% [95% CI 86.5, 97.9]. Although informal methods were timely, they showed poor accuracy to detect dysphagia and may thus put patients at increased risk for poorer outcomes.
They therefore advocate for the use of more formal and psychometrically robust dysphagia screening tools in acute stroke settings.
