• Kaori Nishiwaki, Tetsuya Tsuji, Meigen Liu, Kimitaka Hase, Naofumi Tanaka, and Toshiyuki Fujiwara.
• Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan. kaori@reha.med.keio.ac.jp
• J Rehabil Med. 2005 Jul 1; 37 (4): 247-51.

ObjectiveTo identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke.DesignFactor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test.PatientsSixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan.MethodsFactors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study.ResultsFactor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61-83%) and a specificity of 67% (CI: 55-79%) as a predictor of aspiration (p<0.05).ConclusionWe recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration.

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