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Assessment of aspiration risk in acute ischaemic stroke—evaluation of the simple swallowing provocation test

¹ Department of Neurology, University Hospital of Münster, Münster, Germany
² Department of Neurology, Clinical Centre of Osnabrück, Osnabrück, Germany

Correspondence to:
Tobias Warnecke, MD, Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany; Tobias.Warnecke{at}ukmuenster.de

Objective: To assess the ability of the simple 2-step swallowing provocation test (SPT) to detect aspiration risk in acute stroke patients.

Methods: 100 consecutive patients with first-ever stroke were examined by SPT and fiberoptic endoscopic evaluation of swallowing (FEES) within 72 hours of stroke onset. Using FEES as an objective instrumental technique to evaluate dysphagia, statistical measures representing the ability of SPT to detect aspiration risk were calculated.

Results: The incidence of endoscopically proven aspiration risk was 81%. The 1^st-step SPT had a sensitivity of 74.1% and a specificity of 100%. Although the 2^nd-step SPT showed the same 100% specificity, sensitivity was significantly lower. False-negative results of SPT appeared predominantly in subjects exhibiting leakage of liquids to pyriform sinus without a pronounced delay in swallow onset.

Conclusions: In acute stroke patients with an impairment of the pharyngeal phase of swallowing, 1^st-step SPT reliably detects aspiration risk. In patients with a sole or predominant impairment of the oral phase of swallowing and a relatively intact pharyngeal phase, SPT fails to detect aspiration risk sufficiently. In the latter group, FEES or additional clinical features more specifically indicating oral-phase pathology should be considered to accurately judge the patient’s aspiration risk.