Choosing Wisely:

Don’t order “formal” swallow evaluation in stroke patients unless they fail their initial swallow screen.

Rationale and Comments: Dysphagia (difficulty swallowing) is a common disorder in patients who have suffered a stroke, occurring in 50% to 60% of acute stroke patients. It is associated with an increased risk of aspiration, pneumonia, prolonged hospital stay, disability, and death. Swallow screening is critical in the rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Because formal swallowing evaluation is not warranted in all patients with acute stroke, the purpose of a swallowing screen is to identify those who do not need a formal evaluation and who can safely take food and medication by mouth. Formal swallowing evaluations can be done in patients who don’t pass the initial screening.
Sponsoring Organizations:
  • American Academy of Nursing
  • Sources:
  • Systematic review
  • Disciplines:
  • Neurologic
  • References: • Jauch, E., Saver, J., Adams, H., Bruno, A., Connors, J., Demaerschalk, B., Khatri, P., et al.( 2013) AHA / ASA guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 44, 870-947.
    • Kenmuir, C., Hammer, M., Tudor, J., Reddy, V., Wechsler, L., Jadhav, A., (2015). Predictors of outcome in patients presenting with acute ischemic stroke and mild stroke scale scores. Journal of Stroke and Cerebrovascular Disease. 24(7) 1685-1689.
    • Martino, R., Maki, E., Diamant, N. (2014) Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST): Are 10 teaspoons of water necessary? International Journal of Speech-Language Pathology. 16 (3): 193-198.
    • Schepp, S., Tirschewll, D., Miller, R., Longstreth, W. (2012) Swallowing screens after acute stroke: A systematic review. Stroke. 43, 869-871.
    • Summers, D. Leonard, A., Wentworth, D., Saver, J., Simpson, J., Spilker, J., Hock, N…et al. (2009). Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient. A scientific statement from the American Heart Association. Stroke. 40, 1-35.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now