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Can Emergency Physicians Perform Dysphagia Screening in Acute Stroke Patients?

A simple, easy screening test had a sensitivity of 96% when performed by EPs.

Dysphagia screening is required for all patients with acute stroke before oral intake to prevent aspiration and is a reportable performance metric for stroke centers. Most centers perform screening after patients are admitted, which could increase opportunities for oral intake and aspiration in patients with dysphagia and delay ingestion of nutrition and medications in patients without dysphagia.

In a prospective cohort study of 84 patients who presented to an urban U.S. emergency department with acute stroke, the authors compared the sensitivity of a simple ED dysphagia screening performed by emergency physicians with that of standardized dysphagia screening performed by speech-language pathologists within 24 hours of admission. The ED screen consisted of two steps: The first step involved examination of voice quality, swallowing complaints, facial asymmetry, and aphasia (estimated to take 1 minute); the second step involved a water swallow test to evaluate swallowing difficulty, voice change, and pulse oximetry desaturation 2% (estimated to take 2 minutes). If a patient failed the first step, the second step was not performed. EPs detected dysphagia in 46 of 48 patients detected by speech-language pathologists, yielding a sensitivity of 96%.

Comment: Dysphagia screening is relatively simple and can be performed easily and accurately by many healthcare providers, including nurses, respiratory therapists, speech-language pathologists and, as this study demonstrates, EPs. However, the issue is not whether EPs can perform the screen, but should they? Although patients are unlikely to need oral intake soon after diagnosis of acute stroke, delay in recognizing dysphagia increases the opportunity for avoidable aspiration. ED dysphagia screening to prevent inadvertent aspiration might make sense, but, given the simplicity of the test, it probably could be performed by clinicians less scarce than attending physicians.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine October 16, 2009

Citation(s):

Turner-Lawrence DE et al. A feasibility study of the sensitivity of emergency physician dysphagia screening in acute stroke patients. Ann Emerg Med 2009 Sep; 54:344.

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Reader Remarks:

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• clinical evaluation of patients with stroke
  Joalie Davie, 20 Oct 2009 2:24 PM EST
  I would suspect that a good clinician can accurately diagnose dysphasia based on history and neurological exam which is the... [more]
• dyphagia screening in the ER
  Nancy Brough, MA/CCC-SLP, 20 Oct 2009 2:24 PM EST
  Eric Collins, M.D. and I presented our ER screening plan in 1990 (LAC+USC Medical Center). Stroke patients were first given... [more]
• Dysphagia Assessment
  I. Campbell-Taylor, 9 Nov 2009 3:06 PM EST
  Of course ER physicians, nurses and a host of others can screen for dysphagia. The fact is that physicians can... [more]