Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients

Aim. The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients. Background. The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before. Design. A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies. Data sources. Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015. Review methods. This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies. Results. There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test. Conclusions. This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.