Detection of aspiration and oral intake in dysphagia patients with stroke using two-step water swallowing test

Abstract

Objectives: Dysphagia after stroke is common, and its detection is an important part of stroke management. The purpose of this study was to investigate the clinical utility of water swallowing test using 5 ml and 60 ml for detection of dysphagia.
Subjects and Methods: The subjects were 183 patients with strokes, aged between 20–98 years including 107 males and 76 females, who underwent videofluorography (VF) for suspected swallowing difficulty. Stroke etiology included cerebral infarction in 98 patients, cerebral hemorrhage in 49, subarachnoid hemorrhage in 23, and other cerebral strokes in 23. Before VF, a two-step water swallowing test using 5 ml and 60 ml liquid water was evaluated as bedside clinical assessment. The results of the water swallowing test and VF were compared.
Results: Forty-six of 183 patients were discontinued at the first step (5 ml) because of clinical condition. There are significant correlations between the results of the water swallowing test and aspiration on VF. The sensitivity and specificity of two-step water swallowing test for aspiration were 85.2% and 41.8%, respectively. Foodstuffs and intake methods were related to aspiration detected by VF but they were not related to result of the water swallowing tests.
Conclusion: We concluded that the two-step water swallowing tests are a useful assessment to detect aspiration risk for stroke patients, however, we recommend performing VF before patients begin to eat.