Comparison between bedside clinical assessments of swallowing and videofluoroscopy findings in acute stroke patients

Dysphagia is common after stroke, and its detection is an important part of acute stroke management. In this study, to investigate the clinical factors for aspiration in acute stroke, we compared bedside clinical assessments of swallowing with the findings of videofluoroscopy (VF). The subjects comprised 132 patients with stroke aged between 35 and 97 years, including 78 males and 54 females, in whom VF was performed for swallowing difficulty or suspected swallowing difficulty. They consisted of 94 patients with cerebral infarction, 23 patients with cerebral hemorrhage, and 15 patients with subarachnoid hemorrhage. Before VF, the pharyngeal reflex, physical status, and cognitive function were investigated as bedside clinical assessments. For swallowing evaluation at bedside, the repetitive saliva swallowing test (RSST) and modified water swallowing test (MWST) were performed. As a result, 43 (32.6%) of the 132 patients revealed some difference between the bedside clinical assessments of swallowing and findings obtained by VF. In patients with not only disability of the pharyngeal reflex but also cervical and trunk stability, cognitive dysfunction and aphasia, aspiration should always be supposed and observations for eating behavior against aspiration should be undertaken. In addition, in cases with such physical and cognitive disability at the acute stroke stage, we recommend the use of both tests (bedside clinical tests and VF) to establish the correct findings for swallowing, and it is worth conducting VF when aspiration is suspected based on neurological assessments.