Barnes Jewish Hospital Stroke Dysphagia Screen

Why Use

There are nearly 800,000 cases of acute stroke in the United States every year, with 130,000 associated deaths (4th leading cause of death in Americans). Between 37-78% of acute stroke patients are affected by dysphagia (depending on the study) and these patients have been shown to be at an increased risk of aspiration, which is associated with increased rates of pneumonia, higher morbidity and mortality. The BJH-SDS can simply and reliably allow non-speech pathology trained healthcare professionals screen for patients with dysphagia or aspiration risk.

When to Use

The BJH-SDS can help non-speech pathologists identify stroke patients who are at risk for dysphagia and aspiration, allowing some patients to eat earlier while still preventing aspiration risks.

Formula

Pearls / Pitfalls

The Barnes Jewish Hospital Stroke Dysphagia Screen (BJH-SDS) was designed to create a simple dysphagia screen that health care professionals could use to detect swallowing difficulty in stroke patients quickly and accurately. Specifically designed to be reliably used by practitioners who were not trained speech pathologists . The BJH-SDS has been shown to be sensitive for detecting dysphagia and aspiration risk (94% sensitive/66% specific dysphagia; 95% sensitive/50% specific for aspiration). Points to keep in mind: Some patients with normal swallowing function will have a delay in resuming a normal diet while they wait for evaluation by a speech pathologist, because of the rule’s low specificity. In the original validation study there was a 24 hour gap between applying the screen and the and the gold standard: evaluation by a speech pathologist.

Critical Actions

The BJH-SDS appears to be an easy, reliable and efficient means for non-specialists to identify which patients can be safely advanced to a regular diet after suffering an acute stroke. If for any reason there remain concerns that a patient may be an aspiration risk despite having a negative BJH-SDS evaluation, they should be referred to speech pathology before advancing their diet.

Advice

If a patient completes all components of the BJH-SDS successfully then they can be safely started on a regular diet without the need for evaluation by speech pathology. When evaluating a patient who suffered an acute stroke for potential dysphagia and aspiration risk, the BJH-SDS can be performed by non-specialty trained health care providers to determine which patients can safely tolerate a normal diet and which patients should be referred to speech pathology.