Bedside assessment of swallowing in stroke:: Water tests are not enough

Objective: The clinical functional evaluation is the usual method for dysphagia screening in patients with acute stroke. This study compared two methods of evaluation - with liquid and semisolid viscosities. Method: Twenty-six patients with stroke onset within 7 days - with a mean age of 63.5 +/- 12.4 years - were prospectively evaluated for deficit severity, swallowing mechanisms, chest X-ray studies, and late (30 days after discharge) assessment of disability with the modified Rankin Scale. Results: Tests using water and pudding correlated poorly (p < .001). The water test exhibited higher sensitivity for detection of problems in laryngeal protection, and the test with pudding was more sensitive for the functional analysis of dysphagia itself. Abnormalities in the water test were associated with weak spontaneous cough, while a normal pudding test correlated well with oral feeding 30 days after hospital discharge. The initial neurological severity correlated with results from both tests. No patient had pulmonary infiltrates 72 hours after testing or pneumonia up to 30 days after hospital discharge. Conclusion: The two evaluation methods should be used to both decrease the risk of aspiration and increase the likelihood of a safe and early reintroduction of oral feeding.