Dysphagia screening tools for acute stroke patients available for nurses: A systematic review
-
Isabel de Jesus Oliveira
,
Liliana Andreia Neves da Mota
,
Susana Vaz Freitas
,
Pedro Lopes Ferreira
Abstract
Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses?
Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion.
Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable.
Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.
1. Intercollegiate Stroke Working Party. National clinical guideline for stroke (5th ed.). London: Royal College of Physicians; 2016. P. 85. Available at: https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx. Accessed December 29, 2017.
2. Daniels SK, Schroeder MF, DeGeorge CP, Corey DM, Foundas AL, Rosenbek JC. Defining and Measuring Dysphagia Following Stroke. American Journal of Speech-Language Pathology. 2009 Feb; 18(1): 74-81. doi:10.1044/1058-0360(2008/07-0040)
3. González-Fernández M, Daniels SK. Dysphagia in Stroke and Neurologic Disease. Physical Medicine and Rehabilitation Clinics of North America. 2008 Dec; 19(4): 867-888. doi:10.1016/j.pmr.2008.07.001
4. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors J, Culebras A et al. An Updated Definition of Stroke for the 21st Century - A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2013 Jul; 44(7): 2064-2089. doi:10.1161/STR.0b013e318296aeca
5. Takizawa C, Gemmell E, Kenworthy J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s disease, Alzheimer’s disease, Head Injury, and Pneumonia. Dysphagia. 2016 Jun; 31(3): 434-441. doi:10.1007/s00455-016-9695-96
6. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S et al. Post-stroke dysphagia: A review and design considerations for future trials. International Journal of Stroke. 2016 Jun; 11(4): 399–411. doi:10.1177/1747493016639057
7. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. 2018 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. 2018 Jan; 49(3): e46-e110. doi:10.1161/STR.0000000000000158
8. Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U et al. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. Cerebrovascular Diseases. 2016 Apr; 42(1-2): 81-89. doi:10.1159/000445299
9. Joundi RA, Martino R, Saposnik G, Giannakeas V, Fang J, Kapral MK. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke. Stroke. 2017 Apr; 48(4): 900-906. doi:10.1161/STROKEAHA.116.015332
10. Titsworth WL, Abram J, Fullerton A, Hester J, Guin P, Waters MF, Mocco J. Prospective Quality Initiative to Maximize Dysphagia Screening Reduces Hospital-Acquired Pneumonia Prevalence in Patients With Stroke. Stroke. 2013 Nov; 44(11): 3154-3160. doi:10.1161/STROKEAHA.111.000204
11. Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell HP. Dysphagia Screening: State of the Art. Stroke. 2013 Apr; 44(4): e24-e31. doi:10.1161/STR.0b013e3182877f57
12. Brady S, Donzelli J. The Modified Barium Swallow and the Functional Endoscopic Evaluation of Swallowing. Otolaryngologic Clinics of North America. 2013 Dec; 46(6): 1009-1022. doi:http://dx.doi.org/10.1016/j.otc.2013.08.001
13. Boaden E, Doran D, Burnell J, Burnell J, Dey P, Hurley M et al. Screening for aspiration risk associated with dysphagia in acute stroke (protocol). Cochrane Database of Systematic Reviews. 2017; (6): 13. doi:10.1002/14651858.CD012679
14. Middleton S, Grimley R, Alexandrov AW. Triage, Treatment, and Transfer: Evidence-Based Clinical Practice Recommendations and Models of Nursing Care for the First 72 Hours of Admission to Hospital For Acute Stroke. Stroke. 2015 Feb; 46(2): e18-e25. doi:10.1161/STROKEAHA.114.006139
15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015 Jan; 4(1): 9. doi:10.1186/2046-4053-4-1
16. Akobeng AK. Principles of evidence based medicine. Archives in Disease in Childhood. 2005 Aug; 90(8): 837–840. doi:10.1136/adc.2005.071761
17. Whiting P, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Medical Research Methodology. 2006 Mar; 6(9): 1-8. doi:10.1186/1471-2288-6-9
18. Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against video-fluoroscopy, detects dysphagia and aspiration with high sensitivity. Journal of Stroke and Cerebrovascular Diseases. 2014 Apr; 23(4): 712-716. doi:10.1016/j.jstrokecerebrovasdis.2013.06.030
19. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia Bedside Screening for Acute-Stroke Patients - The Gugging Swallowing Screen. Stroke. 2007 Nov; 38(11): 2948-2952. doi:10.1161/STROKEAHA.107.483933
20. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside Swallowing Screening Test (TOR-BSST) - Development and Validation of a Dysphagia Screening Tool for Patients With Stroke. Stroke. 2009 Feb; 40(2): 555-561. doi:10.1161/STROKEAHA.107.510370
21. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a Dysphagia Screening Tool in Acute Stroke Patients. American Journal of Critical Care. 2010 Jul; 19(4): 357–364. doi:10.4037/ajcc2009961
22. Brott T, Adams Jr HP, Olinger CP, Marler JR, Barsan WG, Biller J et al. Measurements of Acute Cerebral Infarction: A Clinical Examination Scale. Stroke. 1989 Jul; 20(7): 864-870.
23. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Mar; 11(2): 93–98. doi:doi.org/10.1007/BF00417897
24. Mann G. MASA, the Mann assessment of swallowing ability. Clifton Park: Cengage Learning; 2002. P. 5.
25. Almeida TM, Cola PC, Pernambuco LA, Junior HV, Silva RG. Screening tools for oropharyngeal dysphagia in stroke. Audiology - Communication Research. 2015 Oct/Dec; 20(4): 361-370. doi:10.1590/2317-6431-2015-1571
26. Poorjavad M, Jalaie S. Systemic review on highly qualified screening tests for swallowing disorders following stroke: Validity and reliability issues. Journal of Research in Medical Sciences. 2014 Aug; 19(8): 776-785.
27. Schepp SK, Tirschwell DL, Miller RM, Longstreth W. Swallowing Screens After Acute Stroke: A Systematic Review. Stroke. 2012 Mar; 43(3): 869-871. doi:10.1161/STROKEAHA.111.638254
28. Dziewas R, Beck AB, Clave P, Hamdy S, Heppner HJ, Langmore SE et al. Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century. Dysphagia. 2017 Feb; 32(1): 78–82. doi:10.1007/s00455-016-9746-2
29. Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of Neurology, Neurosurgery & Psychiatry. 2017 Jan; 88(1): 25–30. doi:10.1136/jnnp-2016-313356
30. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal Dysphagia Screening Protocols Prevent Pneumonia. Stroke. 2005 Jul; 36(9): 1972-1976. doi:10.1161/01.STR.0000177529.86868.8d
31. Lakshminarayan K, Tsai AW, Tong X, Vazquez G, Peacock JM, George MG et al. Utility of Dysphagia Screening Results in Predicting Poststroke Pneumonia. Stroke. 2010 Dec; 41(12): 2849-2854. doi:10.1161/STROKEAHA.110.597039
32. McHugh M. Interrater reliability: the kappa statistic. Biochemia Medica. 2012; 22(3): 276-282.
33. Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke – the Gugging Swallowing Screen revisited. European Journal of Neurology. 2017 Apr; 24(4): 594-601. doi:doi:10.1111/ene.13251
34. Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Respiratory Infections in Acute Stroke: Nasogastric Tubes and Immobility are Stronger Predictors than Dysphagia. Dysphagia. 2014 Jun; 29(3): 340-345. doi:10.1007/s00455-013-9514-5
35. Kalra L, Hodsoll J, Irshad S, Smithard D, Manawadu D. Association between nasogastric tubes, pneumonia, and clinical outcomes in acute stroke patients. Neurology. 2016 Sep; 87(13): 1352-1359. doi:10.1212/WNL.000000000000315
36. Sørensen RT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. Dysphagia Screening and Intensified Oral Hygiene Reduce Pneumonia After Stroke. Journal of Neuroscience Nursing. 2013 Jun; 45(3): 139-146. doi:10.1097/JNN.0b013e31828a412c
37. Trevethan R. Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Frontiers in Public Health. 2017 Nov; 5(Article 307): 1-7. doi: 10.3389/fpubh.2017.00307
38. Martino R, Beaton D, Diamant NE. Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD). Journal of Clinical Epidemiology. 2009 May; 62(5): 518-526. doi:10.1016/j.jclinepi.2008.05.007
39. Edmiaston J. Dysphagia Screening: Bedside Application and Mechanics of Screening Tools [PDF document]. Available at: https://pdfs.semanticscholar.org/presentation/8e20/8d484e8255173c544d9ad978a0dbd0b0dee0.pdf. Accessed January 31, 2012.
40. Mourão MA, Almeida EO, Lemos SM, Vicente LC, Teixeira AL. Evolution of swallowing in post-acute stroke: a descriptive study. Revista CEFAC. 2016 Mar/Apr; 18(2): 417-425. doi:10.1590/1982-0216201618212315
41. Mandysova P, Škvrňáková J, Ehler E, Černý M. Development of the Brief Bedside Dysphagia Screening Test in the Czech Republic. Nursing & Health Sciences. 2011 Aug; 13(4): 388-395. doi:10.1111/j.1442-2018.2011.00630.x
42. Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review. Tzu Chi Medical Journal. 2016 Jun; 28(2): 41-48. doi:10.1016/j.tcmj.2016.04.006.
2. Daniels SK, Schroeder MF, DeGeorge CP, Corey DM, Foundas AL, Rosenbek JC. Defining and Measuring Dysphagia Following Stroke. American Journal of Speech-Language Pathology. 2009 Feb; 18(1): 74-81. doi:10.1044/1058-0360(2008/07-0040)
3. González-Fernández M, Daniels SK. Dysphagia in Stroke and Neurologic Disease. Physical Medicine and Rehabilitation Clinics of North America. 2008 Dec; 19(4): 867-888. doi:10.1016/j.pmr.2008.07.001
4. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors J, Culebras A et al. An Updated Definition of Stroke for the 21st Century - A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2013 Jul; 44(7): 2064-2089. doi:10.1161/STR.0b013e318296aeca
5. Takizawa C, Gemmell E, Kenworthy J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s disease, Alzheimer’s disease, Head Injury, and Pneumonia. Dysphagia. 2016 Jun; 31(3): 434-441. doi:10.1007/s00455-016-9695-96
6. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S et al. Post-stroke dysphagia: A review and design considerations for future trials. International Journal of Stroke. 2016 Jun; 11(4): 399–411. doi:10.1177/1747493016639057
7. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. 2018 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. 2018 Jan; 49(3): e46-e110. doi:10.1161/STR.0000000000000158
8. Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U et al. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. Cerebrovascular Diseases. 2016 Apr; 42(1-2): 81-89. doi:10.1159/000445299
9. Joundi RA, Martino R, Saposnik G, Giannakeas V, Fang J, Kapral MK. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke. Stroke. 2017 Apr; 48(4): 900-906. doi:10.1161/STROKEAHA.116.015332
10. Titsworth WL, Abram J, Fullerton A, Hester J, Guin P, Waters MF, Mocco J. Prospective Quality Initiative to Maximize Dysphagia Screening Reduces Hospital-Acquired Pneumonia Prevalence in Patients With Stroke. Stroke. 2013 Nov; 44(11): 3154-3160. doi:10.1161/STROKEAHA.111.000204
11. Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell HP. Dysphagia Screening: State of the Art. Stroke. 2013 Apr; 44(4): e24-e31. doi:10.1161/STR.0b013e3182877f57
12. Brady S, Donzelli J. The Modified Barium Swallow and the Functional Endoscopic Evaluation of Swallowing. Otolaryngologic Clinics of North America. 2013 Dec; 46(6): 1009-1022. doi:http://dx.doi.org/10.1016/j.otc.2013.08.001
13. Boaden E, Doran D, Burnell J, Burnell J, Dey P, Hurley M et al. Screening for aspiration risk associated with dysphagia in acute stroke (protocol). Cochrane Database of Systematic Reviews. 2017; (6): 13. doi:10.1002/14651858.CD012679
14. Middleton S, Grimley R, Alexandrov AW. Triage, Treatment, and Transfer: Evidence-Based Clinical Practice Recommendations and Models of Nursing Care for the First 72 Hours of Admission to Hospital For Acute Stroke. Stroke. 2015 Feb; 46(2): e18-e25. doi:10.1161/STROKEAHA.114.006139
15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015 Jan; 4(1): 9. doi:10.1186/2046-4053-4-1
16. Akobeng AK. Principles of evidence based medicine. Archives in Disease in Childhood. 2005 Aug; 90(8): 837–840. doi:10.1136/adc.2005.071761
17. Whiting P, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Medical Research Methodology. 2006 Mar; 6(9): 1-8. doi:10.1186/1471-2288-6-9
18. Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against video-fluoroscopy, detects dysphagia and aspiration with high sensitivity. Journal of Stroke and Cerebrovascular Diseases. 2014 Apr; 23(4): 712-716. doi:10.1016/j.jstrokecerebrovasdis.2013.06.030
19. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia Bedside Screening for Acute-Stroke Patients - The Gugging Swallowing Screen. Stroke. 2007 Nov; 38(11): 2948-2952. doi:10.1161/STROKEAHA.107.483933
20. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside Swallowing Screening Test (TOR-BSST) - Development and Validation of a Dysphagia Screening Tool for Patients With Stroke. Stroke. 2009 Feb; 40(2): 555-561. doi:10.1161/STROKEAHA.107.510370
21. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a Dysphagia Screening Tool in Acute Stroke Patients. American Journal of Critical Care. 2010 Jul; 19(4): 357–364. doi:10.4037/ajcc2009961
22. Brott T, Adams Jr HP, Olinger CP, Marler JR, Barsan WG, Biller J et al. Measurements of Acute Cerebral Infarction: A Clinical Examination Scale. Stroke. 1989 Jul; 20(7): 864-870.
23. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Mar; 11(2): 93–98. doi:doi.org/10.1007/BF00417897
24. Mann G. MASA, the Mann assessment of swallowing ability. Clifton Park: Cengage Learning; 2002. P. 5.
25. Almeida TM, Cola PC, Pernambuco LA, Junior HV, Silva RG. Screening tools for oropharyngeal dysphagia in stroke. Audiology - Communication Research. 2015 Oct/Dec; 20(4): 361-370. doi:10.1590/2317-6431-2015-1571
26. Poorjavad M, Jalaie S. Systemic review on highly qualified screening tests for swallowing disorders following stroke: Validity and reliability issues. Journal of Research in Medical Sciences. 2014 Aug; 19(8): 776-785.
27. Schepp SK, Tirschwell DL, Miller RM, Longstreth W. Swallowing Screens After Acute Stroke: A Systematic Review. Stroke. 2012 Mar; 43(3): 869-871. doi:10.1161/STROKEAHA.111.638254
28. Dziewas R, Beck AB, Clave P, Hamdy S, Heppner HJ, Langmore SE et al. Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century. Dysphagia. 2017 Feb; 32(1): 78–82. doi:10.1007/s00455-016-9746-2
29. Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of Neurology, Neurosurgery & Psychiatry. 2017 Jan; 88(1): 25–30. doi:10.1136/jnnp-2016-313356
30. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal Dysphagia Screening Protocols Prevent Pneumonia. Stroke. 2005 Jul; 36(9): 1972-1976. doi:10.1161/01.STR.0000177529.86868.8d
31. Lakshminarayan K, Tsai AW, Tong X, Vazquez G, Peacock JM, George MG et al. Utility of Dysphagia Screening Results in Predicting Poststroke Pneumonia. Stroke. 2010 Dec; 41(12): 2849-2854. doi:10.1161/STROKEAHA.110.597039
32. McHugh M. Interrater reliability: the kappa statistic. Biochemia Medica. 2012; 22(3): 276-282.
33. Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke – the Gugging Swallowing Screen revisited. European Journal of Neurology. 2017 Apr; 24(4): 594-601. doi:doi:10.1111/ene.13251
34. Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Respiratory Infections in Acute Stroke: Nasogastric Tubes and Immobility are Stronger Predictors than Dysphagia. Dysphagia. 2014 Jun; 29(3): 340-345. doi:10.1007/s00455-013-9514-5
35. Kalra L, Hodsoll J, Irshad S, Smithard D, Manawadu D. Association between nasogastric tubes, pneumonia, and clinical outcomes in acute stroke patients. Neurology. 2016 Sep; 87(13): 1352-1359. doi:10.1212/WNL.000000000000315
36. Sørensen RT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. Dysphagia Screening and Intensified Oral Hygiene Reduce Pneumonia After Stroke. Journal of Neuroscience Nursing. 2013 Jun; 45(3): 139-146. doi:10.1097/JNN.0b013e31828a412c
37. Trevethan R. Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Frontiers in Public Health. 2017 Nov; 5(Article 307): 1-7. doi: 10.3389/fpubh.2017.00307
38. Martino R, Beaton D, Diamant NE. Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD). Journal of Clinical Epidemiology. 2009 May; 62(5): 518-526. doi:10.1016/j.jclinepi.2008.05.007
39. Edmiaston J. Dysphagia Screening: Bedside Application and Mechanics of Screening Tools [PDF document]. Available at: https://pdfs.semanticscholar.org/presentation/8e20/8d484e8255173c544d9ad978a0dbd0b0dee0.pdf. Accessed January 31, 2012.
40. Mourão MA, Almeida EO, Lemos SM, Vicente LC, Teixeira AL. Evolution of swallowing in post-acute stroke: a descriptive study. Revista CEFAC. 2016 Mar/Apr; 18(2): 417-425. doi:10.1590/1982-0216201618212315
41. Mandysova P, Škvrňáková J, Ehler E, Černý M. Development of the Brief Bedside Dysphagia Screening Test in the Czech Republic. Nursing & Health Sciences. 2011 Aug; 13(4): 388-395. doi:10.1111/j.1442-2018.2011.00630.x
42. Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review. Tzu Chi Medical Journal. 2016 Jun; 28(2): 41-48. doi:10.1016/j.tcmj.2016.04.006.
| Files | ||
| Issue | Vol 6 No 3 (2019): Summer | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/npt.v6i3.1253 | |
| Keywords | ||
| screening dysphagia stroke nurse | ||
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How to Cite
1.
Oliveira I, Mota L, Freitas S, Ferreira P. Dysphagia screening tools for acute stroke patients available for nurses: A systematic review. NPT. 2019;6(3):103-115.
