Comparing screening tests for pharyngeal dysphagia in stroke patients

Background Screening for oropharyngeal dysphagia (OPD) in stroke patients is necessary as OPD is a major cause for aspiration pneumonia, nutritional imbalance, and dehydration. it has a poor prognosis and a high mortality rate. This study focused on pharyngeal dysphagia, as it can lead to aspiration pneumonia, which is considered the most serious complication of OPD. Furthermore, the pharyngeal phase is an internal process that cannot be observed during bedside examinations, also the pharyngeal muscles’ function, unlike that of the oral muscles, cannot be examined to predict the efficacy of the pharyngeal phase. Therefore, identifying the highly accurate screening test for pharyngeal dysphagia will prevent misdiagnosis, improve patients’ management, and reduce costs of unnecessary instrumental procedures. This study aimed to compare the screening accuracy of the Volume Viscosity Swallow Test (V-VST), Gugging Swallowing Screen (GUSS) and 3 Ounce Water Swallow test (3 Ounce WST) in detecting pharyngeal dysphagia (PD) in stroke patients for better management and outcomes. Methods A cross-sectional analytic study was conducted in the Phoniatrics Unit of the Otolaryngology Department and the Neurology Unit of the Neuropsychiatry Department. A total of 58 stroke patients were recruited and subjected to the Volume-Viscosity Swallow Test, Gugging Swallowing Screen, 3-ounce Water Swallow Test and Fiberoptic Endoscopic Evaluation of Swallowing. Results A total of 58 stroke patients participated in this study. V-VST reached 55.3% sensitivity and 90% specificity, GUSS reached 81.6% sensitivity and 90% specificity and 3 ounce WST reached 55.3% sensitivity and 85% specificity for detecting pharyngeal residue. While V-VST reached 94.1% sensitivity and 82.9% specificity, GUSS reached 100% sensitivity and 61% specificity and 3 ounce WST reached 88.2% sensitivity and 78% specificity for detecting aspiration. Conclusion GUSS has the highest sensitivity for detecting pharyngeal residue and aspiration compared to V-VST and 3 ounce WST. While the V-VST has the highest specificity for detecting aspiration.