Background and Purpose

Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests.

Methods

Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST.

Results

Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF.

Conclusions

Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure.

中文翻译：

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在急性中风患者的吞咽筛查中，吞咽反射延迟被忽略。

背景和目的

中风急性期的吞咽困难是导致不良结局的重要原因，并与吸入性肺炎和营养不良有关。因此，在开始口服食物摄入之前，必须对吞咽进行准确的评估。改良的吞咽试验（MWST）和重复唾液吞咽试验（RSST）通常用作吞咽功能障碍的床旁筛查方法，但尚不清楚其他因素是否导致吞咽困难和随后的误吸。这项研究的目的是确定筛选测试中可能会忽略的特征。

方法

参与者是从2016年8月1日至2018年6月30日在Suiseikai Kajikawa医院因卒中住院的患者中选择的。入选标准是有意识且稳定的医疗条件，排除了诊断为痴呆的患者。对所有符合纳入/排除标准且同时通过MWST和RSST的患者进行了视频透视（VF）吞咽研究。

结果

吞咽3毫升水时，在172例患者中有16例（9.3％）发生抽吸。这些吸气患者显示吞咽反射对VF明显延迟。

结论

结合使用MWST和RSST进行吞咽评估是相当有效的。但是，表现出吞咽反射延迟的患者可能会被该筛查程序所忽略。