Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct 18;10(10):CD012679.
doi: 10.1002/14651858.CD012679.pub2.

Screening for aspiration risk associated with dysphagia in acute stroke

Elizabeth Boaden  1 , Jane Burnell  2 , Lucy Hives  2 , Paola Dey  3 , Andrew Clegg  2 , Mary W Lyons  4 , C Elizabeth Lightbody  5 , Margaret A Hurley  2 , Hazel Roddam  6 , Elizabeth McInnes  7 , Anne Alexandrov  8 , Caroline L Watkins  5
Affiliations
Review

Screening for aspiration risk associated with dysphagia in acute stroke

Elizabeth Boaden et al. Cochrane Database Syst Rev. .

Abstract

Background: Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties.

Objectives: Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy.

Selection criteria: We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital.

Data collection and analysis: Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests.

Main results: Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests.

Authors' conclusions: We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.

PubMed Disclaimer

Conflict of interest statement

Elizabeth Boaden: none known. Jane Burnell: none known. Lucy Hives: none known. Paola Dey: "my institution has received funding for consultancies and grants in aid from NHS, government and research charities. I have also been in receipt of a travel bursary from the organisers of the United European Gastroenterology Week in Berlin in 2006" Andrew Clegg: none known. Mary W Lyons: none known. C Elizabeth Lightbody: none known. Margaret A Hurley: none known. Hazel Roddam: none known. Elizabeth McInnes: none known. Anne Alexandrov: none known. Caroline L Watkins: none known.

Figures

1
1
PRISMA flow diagram.
2
2
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
3
3
Summary ROC plot of tests: Grouped by Index taxonomy ‐ water only, water plus bolus and other.
4
4
Summary ROC plot of tests grouped by index test healthcare professional ‐ nurse and other.
5
5
Summary ROC plot of tests: grouping index tests by outcome ‐ aspiration and dysphagia.
6
6
Summary ROC plot of tests: index tests grouped by reference test used ‐ Expert Assessment, FEES and VS.
7
7
Forest plot of tests grouped by Index Test Taxonomy ‐ Water only, Water plus other consistencies, and Other tests.
8
8
Forest plot of tests grouped by Reference Test ‐ Expert Assessment and MASA, FEES, and VF.
9
9
Forest plot of tests grouped by Index Test Outcome ‐ aspiration and dysphagia.
10
10
Forest plot of tests grouped by HCP ‐ nurse and other.
1
1. Test
Registered Dietitian (RD) Dysphagia Screening tool ‐ Huhmann (2004)
2
2. Test
Bedside aspiration ‐ Combined WST & Oxygen Saturation ‐ Lim (2001)
3
3. Test
Gugging Swallowing Screen (GUSS) ‐ Group2 ‐ Trappl (2007)
4
4. Test
Toronto Bedside Swallowing Screening Test (TOR‐BSST) ‐ Martino (2009)
5
5. Test
Standardized Swallowing Assessment tool (SSA) ‐ Test2 ‐ Perry (2001) Test2
6
6. Test
Nursing Bedside Dysphagia Screen (NBDS) ‐ Campbell (2016)
7
7. Test
Emergency Department (ED) dysphagia screen ‐ Turner‐Lawrence (2009)
8
8. Test
Acute Stroke Dysphagia Screening (ASDS) ‐ Aspiration ‐ Edmiaston (2010)
9
9. Test
Barnes‐Jewish Hospital‐Stroke Dysphagia Screen (BJH‐SDS) Aspiration ‐ Edmiaston (2014)
10
10. Test
Edith‐Huhn‐Matesic Bedside Aspiration Screen (EHMBAS) plus water swallow test ‐ Huhn‐Matesic (2015)
11
11. Test
Standardized Swallowing Assessment tool (SSA) ‐ Test1 ‐ Perry (2001)
12
12. Test
Barnes‐Jewish Hospital‐Stroke Dysphagia Screen (BJH‐SDS) Dysphagia ‐ Edmiaston (2014)
13
13. Test
Modified MASA (MMASA) Neurologist 1 ‐ Antonios (2010)
14
14. Test
Rapid Aspiration Screening for Suspected Stroke (RAS3) ‐ Daniels (2016)
15
15. Test
Clinical examination ‐ Daniels (1997)
16
16. Test
Acute Stroke Dysphagia Screening (ASDS) Dysphagia ‐ Edmiaston (2010)
17
17. Test
Nurse Dysphagia Screen ‐ Cummings (2015)
18
18. Test
Modified MASA (MMASA) Neurologist 2 ‐ Antonios (2010)
19
19. Test
Oxygen saturation ≥ 2% ‐ Test2 for Aspiration ‐ Smith (2000)
20
20. Test
Bedside swallow test ‐ WST only ‐ Lim (2001)
21
21. Test
Chinese version of the modified SSA original 8 items ‐ Jiang (2019)
22
22. Test
Chinese version of the modified SSA reduced 6 items ‐ Jiang (2019)
23
23. Test
Stroke Severity using National Institutes of Health Stroke Scale (NIHSS) ‐ Bravata (2009)
24
24. Test
Nursing Bedside Swallowing Screen (NBSS) ‐ Ellis (2013)
25
25. Test
2‐step Swallowing Provocation Test (SPT) ‐ step 1 ‐ 0.4 mL ‐ Warneke (2008)
26
26. Test
Rapid Aspiration Screening for Suspected Stroke (RAS3) ‐ WST only ‐ Daniels (2016)
27
27. Test
Gag function ‐ Test3 ‐ Perry (2001)
28
28. Test
DePaul Hospital Swallow Screener (DHSS) for Aspiration Risk ‐ Behera (2018)
29
29. Test
DePaul Hospital Swallow Screener (DHSS) for Dysphagia ‐ Behera (2018)
30
30. Test
Gag function ‐ Test4 ‐ Perry (2001)
31
31. Test
2‐step swallowing provocation test (SPT) step 2 ‐ 2.0 mL ‐ Warneke (2008)
32
32. Test
Johns Hopkins Hospital Brain Rescue Unit Modified 3 oz Swallow Screen ‐ Mulheren (2019)
33
33. Test
Nursing Screening Tool ‐ Bravata (2009)
34
34. Test
Barnes‐Jewish Hospital Stroke Dysphagia Screen (BJH‐SDS) – Turkish version (T‐BJH) ‐ Eren (2019)
35
35. Test
Clinical Predicative Scale of Aspiration (CPSA) ‐ Zhou (2011)
36
36. Test
TOR‐BSST water swallow item ‐ Martino (2014)
37
37. Test
Clinical swallowing tests ‐ 6 oromotor examinations ‐ Nishiwaki (2005)
38
38. Test
Index taxonomy ‐ water only
39
39. Test
Index taxonomy ‐ water plus other consistencies
40
40. Test
Index taxonomy ‐ other
41
41. Test
Outcome ‐ aspiration
42
42. Test
Outcome ‐ dysphagia
43
43. Test
Reference test ‐ Expert Assessment and MASA
44
44. Test
Reference test ‐ FEES
45
45. Test
Reference test ‐ VF
46
46. Test
HCP ‐ nurse
47
47. Test
HCP ‐ other
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012679

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Antonios 2010 {published data only}
    1. Antonios N, Carnaby-Mann G, Crary M, Miller L, Hubbard H, Hood K, et al. Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit: the Modified Mann Assessment of Swallowing Ability. Journal of Stroke and Cerebrovascular Diseases 2010;19(1):49-57. - PubMed
Behera 2018 {published data only}
    1. Behera A, Read D, Jackson N, Saour B, Alshekhlee D, Mosier AK. A validated swallow screener for dysphagia and aspiration in patients with stroke. Journal of Stroke and Cerebrovascular Diseases 2018;27(7):1897-904. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.038] - DOI - PubMed
Bravata 2009 {published data only}
    1. Bravata DM, Daggett VS, Woodward-Hagg H, Damush T, Plue L, Russell S, et al. Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health Stroke Scale. Journal of Rehabilitation Research and Development 2009;46(9):1127-33. - PubMed
Campbell 2016 {published data only}
    1. Campbell GB, Carter T, Kring D, Martinez C. Nursing bedside dysphagia screen: is it valid? Journal of Neuroscience Nursing 2016;48(2):75-9. - PubMed
Cummings 2015 {published data only}
    1. Cummings J, Soomans D, O'Laughlin J, Snapp V, Jodoin A, Proco H, et al. Sensitivity and specificity of a nurse dysphagia screen in stroke patients. MEDSURG Nursing 2015;24(4):219-63. - PubMed
Daniels 1997 {published data only}
    1. Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical assessment of swallowing and prediction of dysphagia severity. American Journal of Speech-Language Pathology 1997;6(4):17-24.
Daniels 2016 {published data only}
    1. Daniels SK, Pathak S, Rosenbek JC, Morgan RO, Anderson JA. Rapid aspiration screening for suspected stroke: part 1: development and validation. Archives of Physical Medicine and Rehabilitation 2016;97(9):1440-8. - PubMed
Edmiaston 2010 {published data only}
    1. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. American Journal of Critical Care 2010;19(4):357-64. - PMC - PubMed
Edmiaston 2014 {published data only}
    1. Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. Journal of Stroke and Cerebrovascular Diseases 2014;23(4):712-6. - PMC - PubMed
Ellis 2013 {published data only}
    1. Ellis AL, Hannibal RR. Nursing swallow screens: why is testing water only not enough? Journal of Neuroscience Nursing 2013;45(5):244-53. - PubMed
Eren 2019 {published data only}
    1. Eren Y, Karaca EU, Saylam G, Yaylaci A, Alicura S, Çomoğlu SS. Validity and reliability of the Turkish version of the Barnes-Jewish Hospital stroke dysphagia screen test in patients with acute stroke. Neurological Sciences and Neurophysiology 2019;36(2):78-83. [DOI: 10.5152/NSN.2019.10815] - DOI
Huhmann 2004 {published data only}
    1. Huhmann M, Decker RT, Byham-Gray L, Maillet JO, VonHagen S. Comparison of dysphagia screening by a registered dietitian in acute stroke patients to speech language pathologist's evaluation. Topics in Clinical Nutrition 2004;19(3):239-49.
Huhn‐Matesic 2015 {published data only}
    1. Huhn-Matesic EK. Developing and testing a bedside aspiration screen to protect stroke patients from aspiration and mortality. Clinical Scholars Review 2015;8(1):117-24. [DOI: 10.1891/1939-2095.8.1.117] - DOI
Jiang 2019 {published data only}
    1. Jiang J, Yu J, Wang J, Wang Y, Wang W. Evaluation of the Chinese version of the swallowing screen in stroke patients with dysphagia. Tzu Chi Medical Journal 2019;31(4):270-5. [DOI: 10.4103/tcmj.tcmj_158_18] - DOI - PMC - PubMed
Lim 2001 {published data only}
    1. Lim SHB, Lieu PK, Phua SY, Seshadri R, Venketasubramanian N, Lee SH, et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 2001;16(1):1-6. - PubMed
Martino 2009 Study 1 {published data only}
    1. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, et al. The Toronto Bedside Swallowing Screening Test (TOR-BSST) development and validation of a dysphagia screening tool for patients with stroke. Stroke 2009;40(2):555-61. - PubMed
Martino 2014 {published data only}
    1. Martino R, Maki E, Diamant N. Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST®): are 10 teaspoons of water necessary? International Journal of Speech-Language Pathology 2014;16(3):193-8. - PubMed
Mulheren 2019 {published data only}
    1. Mulheren RW, González-Fernández M. Swallow screen associated with airway protection and dysphagia after acute stroke. Archives of Physical Medicine and Rehabilitation 2019;100(7):1289-93. [DOI: 10.1016/j.apmr.2018.12.032] - DOI - PubMed
Nishiwaki 2005 {published data only}
    1. Nishiwaki K, Tsuji T, Liu M, Hase K, Tanaka N, Fujiwara T. Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia. Journal of Rehabilitation Medicine 2005;37:247-51. - PubMed
Perry 2001 Study 1 {published data only}
    1. Perry L. Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses. Journal of Clinical Nursing 2001;10(4):463-73. - PubMed
Smith 2000 {published data only}
    1. Smith HA, Lee SH, O'Neill PA, Connolly MJ. The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. Age and Ageing 2000;29(6):495-9. - PubMed
Trapl 2007 {published data only}
    1. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007;38(11):2948-52. - PubMed
Turner‐Lawrence 2009 {published data only}
    1. Turner-Lawrence DE, Peebles M, Price MF, Singh SJ, Asimos AW. A feasibility study of the Sensitivity of Emergency Physician Dysphagia Screening in acute stroke patients. Annals of Emergency Medicine 2009;54(3):344-8.e1. - PubMed
Warnecke 2008 {published data only}
    1. Warnecke T, Teismann I, Meimann W, Olenberg S, Zimmermann J, Kramer C, et al. Assessment of aspiration risk in acute ischaemic stroke - evaluation of the simple swallowing provocation test. Journal of Neurology, Neurosurgery and Psychiatry 2008;79(3):312-4. - PubMed
Zhou 2011 {published data only}
    1. Zhou Z, Salle JY, Daviet JC, Stuit A, Nguyen CL. Combined approach in bedside assessment of aspiration risk post stroke: PASS. European Journal of Physical and Rehabilitation Medicine 2011;47(3):441-6. - PubMed

References to studies excluded from this review

Addington 1999 Study 1 {published data only}
    1. Addington WR, Stephens RE, Gilliland K, Rodriguez M. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke. Archives of Physical Medicine and Rehabilitation 1999;80(2):150-4. - PubMed
Addington 1999 Study 2 {published data only}
    1. Addington WR, Stephens RE, Gilliland KA. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke 1999;30(6):1203-7. - PubMed
Alsibai 2014 {published data only}
    1. Alsibai A, Voytas J. Use of electrical stimulation in treatment of dysphagia, a nursing home experience. Journal of the American Geriatrics Society 2014;62:S37.
Anderson 2016 {published data only}
    1. Anderson JA, Pathak S, Rosenbek JC, Morgan RO, Daniels SK. Rapid aspiration screening for suspected stroke: Part 2: initial and sustained nurse accuracy and reliability. Archives of Physical Medicine and Rehabilitation 2016;97(9):1449-55. - PubMed
Archer 2015 Study 1 {published data only}
    1. Archer S, Smith C, Newham D. Surface electromyography biofeedback in dysphagia therapy: do patients think it helps? International Journal of Stroke 2015;10:63.
Archer 2015 Study 2 {published data only}
    1. Archer S, Smith C, Newham D. Surface electromyographic biofeedback and the effortful swallow exercise for stroke-related dysphagia. International Journal of Stroke 2015;10:63. - PMC - PubMed
Armesto 2015 {published data only}
    1. Armesto A, Howald R, Roseman E, Kitchen-Clark T, Convery C, Boyle K, et al. Swallowing screening in the emergency department: a collaborative effort to improve patient care. International Journal of Stroke 2015;10:59-60.
Aviv 1997 {published data only}
    1. Aviv JE, Sacco RL, Mohr JP, Thompson JLP, Levin B, Sunshine S, et al. Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke. Laryngoscope 1997;107(9):1254-60. - PubMed
Aydogdu 2015 {published data only}
    1. Aydogdu I, Kiylioglu N, Tarlaci S, Tanriverdi Z, Alpaydin S, Acarer A, et al. Diagnostic value of "dysphagia limit" for neurogenic dysphagia: 17 years of experience in 1278 adults. Clinical Neurophysiology 2015;126(3):634-43. - PubMed
Babi 2014 {published data only}
    1. Babi MA, Gorman M, Commichau C, Kenney S, Boyle L, Comeau M, et al. Failed bedside dysphagia screen predicts pneumonia treatment in acute stroke: a resident quality initiative project in a JC-certified primary stroke center. Neurology 2014;82(10 Suppl 1).
Bahia 2014 {published data only}
    1. Bahia MM, Mourao LF, Lima FO, Li LM. Clinical predictors of oropharyngeal dysphagia following acute stroke. Dysphagia 2014;29(6):774.
Bahia 2016 {published data only}
    1. Bahia MM, Mourao LF, Chun RYS. Dysarthria as a predictor of dysphagia following stroke. NeuroRehabilitation 2016;38(2):155-62. - PubMed
Bax 2013 {published data only}
    1. Bax L, McFarlane M, Green E, Miles A. Introducing a speech and language therapy (SLT) led fibre optic endoscopic evaluation of swallowing (FEES): functional outcomes for acute stroke patients. International Journal of Stroke 2013;8:40.
Bax 2014 {published data only}
    1. Bax L, McFarlane M, Green E, Miles A. Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: functional outcomes for patients after stroke. Journal of Stroke and Cerebrovascular Diseases 2014;23(3):e195-e200. - PubMed
Benjamin 2015 {published data only}
    1. Bax L, McFarlane M, Green E, Miles A. Introducing a speech and language therapy (SLT) led fibre optic endoscopic evaluation of swallowing (FEES): functional outcomes for acute stroke patients. International Journal of Stroke 2013;8:40.
Burks 2011 {published data only}
    1. Burks C, Meyer DM. Validation of the TOR-BSST swallow screening tool. Stroke 2011;42(3):e129-e130.
Carnaby 2014 {published data only}
    1. Carnaby GD. Relationships among videofluoroscopic scales and stroke outcome. Dysphagia 2014;29(6):751.
Carrington 2013 {published data only}
    1. Carrington S, Archer S, Smith C. Evaluating the impact of fibreoptic endoscopic (FEES) evaluation of swallowing with dysphagic patients on a stroke unit. International Journal of Stroke 2013;8:27.
Chavarria 2015 {published data only}
    1. Chavarria M, Arauz A, Barboza M, Patino M, Becerril M. Scale for severe dysphagia in lateral medullary stroke. Journal of the Neurological Sciences 2015;357:e108.
Choi 2010 {published data only}
    1. Choi MG, Sung HY, Kim JS, Cho YK, Park JM, Lee IS, et al. Usefulness of dysphagia screening protocol including high resolution manometry in acute cerebrovascular accident. Gastroenterology 2010;138(5 Suppl 1):S346.
Chong 2003 {published data only}
    1. Chong MS, Lieu PK, Sitoh YY, Meng YY, Leow LP. Bedside clinical methods useful as screening test for aspiration in elderly patients with recent and previous strokes. Annals of the Academy of Medicine Singapore 2003;32(6):790-4. - PubMed
Cichero 2009 {published data only}
    1. Cichero JA, Heaton S, Bassett L. Triaging dysphagia: nurse screening for dysphagia in an acute hospital. Journal of Clinical Nursing 2009;18(11):1649-59. - PubMed
Clayton 2006 {published data only}
    1. Clayton J, Jack CIA, Ryall C, Tran J, Hilal E, Gosney M. Tracheal pH monitoring and aspiration in acute stroke. Age and Ageing 2006;35(1):47-53. - PubMed
Collins 1997 {published data only}
    1. Collins MJ, Bakheit AMO. Does pulse oximetry reliably detect aspiration in dysphagic stroke patients? Stroke 1997;28(9):1773-5. - PubMed
Crary 2013 Study 1 {published data only}
    1. Crary M, Carnaby G, Sura L, Sia I, Rolon S, Levien E, et al. Spontaneous swallow frequency identifies dysphagia in acute stroke. Dysphagia 2013;28(4):612.
Crary 2013 Study 2 {published data only}
    1. Crary M, Carnaby-Mann G, Sura L, Sia I. Spontaneous swallow frequency as a screening protocol for dysphagia in acute stroke. Neurology 2013;80(1 Meeting Abstracts).
Crary 2014 Study 1 {published data only}
    1. Crary M, Carnaby G. Multidisciplinary clinical rehabilitation spontaneous swallow frequency and dysphagia/stroke related outcomes in acute stroke. International Journal of Stroke 2014;9:220.
Crary 2014 Study 2 {published data only}
    1. Crary MA, Carnaby GD, Sia I. Spontaneous swallow frequency compared with clinical screening in the identification of dysphagia in acute stroke. Journal of Stroke and Cerebrovascular Diseases 2014;23(8):2047-53. - PMC - PubMed
Daniels 2009 {published data only}
    1. Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Foundas AL, Rosenbek JC. Defining and measuring dysphagia following stroke. American Journal of Speech-Language Pathology 2009;18(1):74-81. - PubMed
Davis‐De Geus 2009 {published data only}
    1. Davis-De Geus M. Using an evidence-based bedside swallow screen for all stroke patients: how health care providers can improve stroke patients' outcomes. Dysphagia 2009;24(4):463.
DePippo 1992 {published data only}
    1. DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Archives of Neurology 1992;49(12):1259-61. - PubMed
Farneti 2015 {published data only}
    1. Farneti D, Prencipe RS, Montano L, Nicolini L, Genovese E. Reliability of screening and bedside procedures in the management of acute stroke patients in a community hospital. Dysphagia 2015;30(5):626.
Giraldo‐Cadavid 2015 {published data only}
    1. Giraldo-Cadavid LF, Burguete J, Rueda F, Galvis AM, Castaneda N, Arbulu M, et al. Accuracy of the laryngeal adductor reflex explored by a new laryngo-pharyngeal esthesiometer during the fiberoptic endoscopic evaluation of swallowing. American Journal of Respiratory and Critical Care Medicine 2015;191:A2123.
Guerra 2011 {published data only}
    1. Guerra L, Ottaviani C, Grazia Scucchi M, Amendola L, Macchiaolo S, Capecchi D, et al. Assessment of dysphagia in acute stroke: analysis of degree of agreement between nurses. L'Infermiere 2011;48(2):e9-13.
Guillén‐Solà 2011 {published data only}
    1. Guillén-Solà A, Martínez-Orfila J, Gómez RB, Castelló SM, Marco E. Screening of swallowing disorders in stroke: utility of clinical signs and clinical examination method of volume-viscosity in comparison with videofluoroscopy. Rehabilitacion 2011;45(4):293-300.
Guillén‐Solà 2013 {published data only}
    1. Guillen-Sola A, Marco E, Martinez-Orfila J, Donaire Mejias MF, Depolo Passalacqua M, Duarte E, et al. Usefulness of the volume-viscosity swallow test for screening dysphagia in subacute stroke patients in rehabilitation income. NeuroRehabilitation 2013;33(4):631-8. - PubMed
Gurcay 2018 {published data only}
    1. Gurcay E, Bahceci K, Ozturk E, Yilmaz V, Gundogdu I, Ceylan T, et al. Validity and reliability of Turkish version of the gugging swallowing screen test in the early period of hemispheric stroke. Neurological Sciences and Neurophysiology 2018;35(1):6-13.
Higo 2003 {published data only}
    1. Higo R, Tayama N, Watanabe T, Nito T. Pulse oximetry monitoring for the evaluation of swallowing function. European Archives of Oto-Rhino-Laryngology 2003;260(3):124-7. - PubMed
Joundi 2017 {published data only}
    1. Joundi RA, Martino R, Saposnik G, Giannakeas V, Jiming F, Kapral MK, et al. Predictors and outcomes of dysphagia screening after acute ischemic stroke. Stroke 2017;48(4):900-6. - PubMed
Karaca 2018 {published data only}
    1. Karaca Umay E, Gundogdu I, Gurcay E, Ozturk E, Yilmaz V, Karaahmet O, et al. The psychometric evaluation of the Turkish version of the Mann assessment of swallowing ability in patients in the early period after stroke. Turkish Journal of Medical Sciences 2018;48(6):1153-61. - PubMed
Logemann 1999 {published data only}
    1. Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia 1999;14(1):44-51. - PubMed
Mandysova 2015 {published data only}
    1. Mandysova P, Ehler E, Skvrnakova J, Cerny M, Bartova I, Pellant A. Development of the Brief Bedside Dysphagia Screening Test - Revised: a cross-sectional Czech study. Acta Medica (Hradec Kralove) 2015;58:49-55. - PubMed
Marques 2008 {published data only}
    1. Marques CHD, De Rosso ALZ, Andre C. Bedside assessment of swallowing in stroke: water tests are not enough. Topics in Stroke Rehabilitation 2008;15(4):378-83. - PubMed
Martino 2009 Study 2 {published data only}
    1. Martino R, Streiner D, Maki E, Diamant N. A sensitivity analysis to determine whether ten teaspoons of water are really necessary. Dysphagia 2009;24(4):473.
Massey 2002 {published data only}
    1. Massey R, Jedlicka D. The Massey Bedside Swallowing Screen. Journal of Neuroscience Nursing 2002;34(5):252-60. - PubMed
McCullough 2001 {published data only}
    1. McCullough GH, Wertz RT, Rosenbek JC. Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke. Journal of Communication Disorders 2001;34(1-2):55-72. - PubMed
McCullough 2005 {published data only}
    1. McCullough GH, Rosenbek JC, Wertz RT, McCoy S, Mann G, McCullough K. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. Journal of Speech, Language, and Hearing Research 2005;48(6):1280-93. - PubMed
Moalli 2016 {published data only}
    1. Moalli D, Dell'Angelo D, Bedard L. CVAS: a rapid dysphagia evaluation tool. Connecticut Medicine 2016;80(4):205-7. - PubMed
Moon 2010 {published data only}
    1. Moon KH, Sohn HS, Lee ES, Paek EK, Kang EJ, Lee SH, et al. Comparison for risk estimate of aspiration between the revised dysphagia assessment tool and videofluoroscopy in post-stroke patients. Journal of Korean Academy of Nursing 2010;40(3):359-66. - PubMed
Mozzanica 2017 {published data only}
    1. Mozzanica F, Scarponi L, Pedrali S, Pizzorni N, Pinotti C, Foieni F, et al. Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool [Screening della disfagia nelle unita di cure sub-acute utilizzando la versione italiana del Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool]. Acta Otorhinolaryngologica Italica 2017;37(1):25-31. - PMC - PubMed
Murray 2011 {published data only}
    1. Murray J, Milich A, Ormerod D. Screening for dysphagia. Australian Nursing Journal 2011;18(11):44-6. - PubMed
NCT00306501 {published data only}
    1. NCT00306501. Volitional swallowing in stroke patients with chronic dysphagia. https://clinicaltrials.gov/ct2/show/record/NCT00306501 (first received 23 March 2006).
NCT00580138 {published data only}
    1. NCT00580138. Real-time Internet evaluation of swallowing. https://clinicaltrials.gov/ct2/show/NCT00580138 (first received 24 December 2007).
NCT01765673 {published data only}
    1. NCT01765673. The Passy Muir Swallowing Self Training Device (PMSST). https://clinicaltrials.gov/ct2/show/NCT01765673 (first received 10 January 2013).
NCT02080988 {published data only}
    1. NCT02080988. Reflexive coughing force in severe aspirators. https://clinicaltrials.gov/ct2/show/NCT02080988 (first received 7 March 2014).
NCT02848664 {published data only}
    1. NCT02848664. Use of the Passy Muir Swallowing Self Trainer. https://clinicaltrials.gov/ct2/show/NCT02848664 (first received 28 July 2016).
NCT03167892 {published data only}
    1. NCT03167892. Oral Screens in Post Stroke Training. https://clinicaltrials.gov/ct2/show/NCT03167892 (first received 30 May 2017).
Nomura 2014 {published data only}
    1. Nomura JT, Poole CL, Boyer BW, Papas MA, Thomas J, Gregore DR, et al. Customized swallow screening tool to exclude aspiration pneumonia risk in acute stroke patients. Academic Emergency Medicine 2014;21(5 Suppl 1):S257.
Oh 2016 {published data only}
    1. Oh JC, Park JH, Jung MY, Yoo EY, Chang KY, Lee TY. Relationship between quantified instrumental swallowing examination and comprehensive clinical swallowing examination. Occupational Therapy International 2016;23(1):3-10. - PubMed
Ohira 2013 {published data only}
    1. Ohira M, Ishida R, Maki Y, Okubo M, Sugiyama T, Sakayori T, et al. Evaluation of swallowing ability using Mann assessment of swallowing ability (MASA) of dependent elderly in Japan. Dysphagia 2013;28(4):635. - PubMed
Ohira 2017 {published data only}
    1. Ohira M, Ishida R, Maki Y, Ohkubo M, Sugiyama T, Sakayori T, Sato T. Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults. Geriatrics & Gerontology International 2017;17(4):561-7. - PubMed
Osawa 2013 {published data only}
    1. Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovascular Diseases 2013;35(3):276-81. - PubMed
Ostrofsky 2016 {published data only}
    1. Ostrofsky C, Seedat J. The South African dysphagia screening tool (SADS): a screening tool for a developing context. South African Journal of Communication Disorders 2016;63(1):1-9. - PMC - PubMed
Palli 2017 {published data only}
    1. Palli C, Fandler S, Doppelhofer K, Niederkorn K, Enzinger C, Vetta C, et al. Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: a clinical intervention study. Stroke 2017;48(9):2583-5. - PubMed
Pennsylvania Patient Safety Authority 2009 {published data only}
    1. Pennsylvania Patient Safety Authority. Does your admission screening adequately predict aspiration risk? Pennsylvania Patient Safety Authority 2009;6(4):115-21. [http://patientsafety.pa.gov/ADVISORIES/Pages/200912_115.aspx]
Perry 2000 {published data only}
    1. Perry L, McLaren SM. Dysphagia screening, assessment and outcomes in stroke patients: Phase 1 of an evidence-based practice project. Journal of Clinical Excellence 2000;1(4):201-8.
Perry 2001 Study 2 {published data only}
    1. Perry L. Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses. Journal of Clinical Nursing 2001;10(4):474-81. - PubMed
Radhakrishnan 2013 {published data only}
    1. Radhakrishnan S, Menon UK, Anandakuttan A. A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia: a pilot study. Annals of Indian Academy of Neurology 2013;16(3):388-93. - PMC - PubMed
Rosenbek 2004 {published data only}
    1. Rosenbek JC, McCullough GH, Wertz RT. Is the information about a test important? Applying the methods of evidence-based medicine to the clinical examination of swallowing. Journal of Communication Disorders 2004;37(5):437-50. - PubMed
Sato 2012 {published data only}
    1. Sato M, Tohara H, Iida T, Wada S, Inoue M, Ueda K. Simplified cough test for screening silent aspiration. Archives of Physical Medicine and Rehabilitation 2012;93(11):1982-6. - PubMed
Schrock 2011 {published data only}
    1. Schrock JW, Bernstein J, Glasenapp M, Drogell K, Hanna J. A novel emergency department dysphagia screen for patients presenting with acute stroke. Academic Emergency Medicine 2011;18(6):584-9. - PubMed
Sellars 1998 {published data only}
    1. Sellars C, Dunnet C, Carter R. A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Dysphagia 1998;13(2):82-6. - PubMed
Smith Hammond 2009 {published data only}
    1. Smith Hammond CA, Goldstein LB, Horner RD, Ying J, Gray L, Gonzalez-Rothi L, et al. Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest 2009;135(3):769-77. - PMC - PubMed
Sohn 2018 {published data only}
    1. Sohn D, Park G-Y, Koo HJ, Jang YJ, Han Y, Im S. Determining peak cough flow cutoff values to predict aspiration pneumonia among patients with dysphagia using the Citric Acid Reflexive Cough Test. Archives of Physical Medicine & Rehabilitation 2018;99(12):2532-9. - PubMed
Soria 2013 {published data only}
    1. Soria F, Furkim AM, Nunes MC, Pinto G, Lange M, Zetola V. Identification risk of aspiration pneumonia in two groups of patients with stroke. Dysphagia 2013;28(2):325-6.
Stroke and Chewing 2012 {published data only}
    1. Stroke and chewing. Dental Abstracts 2012;57(3):165.
Sung 2018 {published data only}
    1. Sung HY, Lee KS, Choi MG, Kim JS. Dysphagia screening using high-resolution impedance manometry in acute stroke. International Journal of Gerontology 2018;12(2):110-5.
Sørensen 2013 {published data only}
    1. 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;45(3):139-46. - PubMed
Tanuma 2002 {published data only}
    1. Tanuma S, Sudo E, Takahashi Y, Yoshida A, Kobayashi C, Ohama Y. The usefulness of the water swallowing test and videofluorography in swallowing rehabilitation in patients with cerebrovascular disease. Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 2002;39(4):427-32. - PubMed
Teramoto 2000 {published data only}
    1. Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Archives of Physical Medicine and Rehabilitation 2000;81(11):1517-9. - PubMed
Toscano 2019 {published data only}
    1. Toscano M, Vigano A, Rea A, Verzina A, Sasso D'Elia T, Puledda F, et al. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. European Journal of Neurology 2019;26(4):596-602. - PubMed
Tuncay 2011 {published data only}
    1. Tuncay F, Tasbas Ö, Borman P, Geçene M, Coskun Ö. The bedside clinical evaluation of swallowing function of stroke patients in acute stage. Journal of Physical Medicine & Rehabilitation Sciences 2011;14(2):33-8.
Umay 2013 {published data only}
    1. Umay E, Unlu E, Kilic G, Cakci A, Korkmaz H. Evaluation of dysphagia in early period stroke patients by bedside screening test, endoscopic and electrophysiological methods. Dysphagia 2013;28(3):395-403. - PubMed
Virvidaki 2019 {published data only}
    1. Virvidaki IE, Giannopoulos S, Nasios G, Dimakopoulos G, Michou E, Milionis H. Predictive value of a novel pragmatic tool for post-stroke aspiration risk: the Functional Bedside Aspiration Screen. Neurogastroenterology and Motility 2019;31(10):e13683. - PubMed
Warnecke 2017 {published data only}
    1. 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;24(4):594-601. - PubMed
Weinhardt 2008 {published data only}
    1. Weinhardt J, Hazelett S, Barrett D, Lada R, Enos T, Keleman R. Accuracy of a bedside dysphagia screening: a comparison of registered nurses and speech therapists. Rehabilitation Nursing 2008;33(6):247-52. - PubMed
Ye 2018 {published data only}
    1. Ye T, Huang SY, Dong Y, Dong Q. Bedside modified volume-viscosity swallow test might be reliably to predict risk of aspiration pneumonia after stroke. Stroke 2019;50 Suppl 1:AWP479.
Yeh 2011 {published data only}
    1. Yeh SJ, Huang KY, Wang TG, Chen YC, Chen CH, Tang SC, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. Journal of the Neurological Sciences 2011;306(1-2):38-41. - PubMed
Zhang 2004 {published data only}
    1. Zhang J, Wang YJ, Cui T. Reliability and validity of nine rating scales for dysphagia following stroke. Chinese Journal of Clinical Rehabilitation 2004;8(7):1201-3.

Additional references

Almeida 2015
    1. Almeida TM, Cola PC, Pernambuco LA, Magalhaes HV Jr, Silva RG. Screening tools for oropharyngeal dysphagia in stroke. Audiology - Communication Research 2015;20(4):361-70.
Avan 2019
    1. Avan A, Digaleh H, Di Napoli M, Stranges S, Behrouz R, Shojaeianbabaei G, et al. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study. BMC Medicine 2019;17(191). [DOI: 10.1186/s12916-019-1397-3] - DOI - PMC - PubMed
Benfield 2020
    1. Benfield JK, Everton LF, Bath PM, England TJ. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: a systematic review and meta‐analysis. Journal of Clinical Nursing 2020;29(9-10):1527-38. [DOI: 10.1111/jocn.15192] - DOI - PubMed
Blitzer 1988
    1. Blitzer A, Krespi YP, Oppenheimer RW, Levine TM. Surgical management of aspiration. Otolaryngologic Clinics of North America 1988;4:743–50. - PubMed
Boaden 2011
    1. Boaden EE. Improving the identification and management of aspiration after stroke [Doctoral thesis]. University of Central Lancashire 2011.
Bray 2016
    1. 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 and Psychiatry 2017;88(1):25-30. - PubMed
Brodsky 2016
    1. Brodsky MB, Suiter DM, Gonzalez-Fernandez M, Michtalik HJ, Frymark TB, Venediktov R, et al. Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis. Chest 2016;150(1):148-63. - PMC - PubMed
CADTH 2018
    1. CADTH. Grey matters: a practical tool for searching health-related grey literature [Internet]. Available from https://www.cadth.ca/resources/finding-evidence 2018.
Chen 2016
    1. Chen PC, Chuang CH, Leong CP, Guo SE, Hsin YJ. Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients. Journal of Advanced Nursing 2016;72(11):2575-86. [DOI: 10.1111/jan.13013] - DOI - PubMed
Daniels 2012
    1. Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke. Stroke 2012;43(3):892-7. - PubMed
Donovan 2013
    1. Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke 2013;44(4):e24-31. - PubMed
European Stroke Organisation 2015
    1. European Stroke Organisation. The European Stroke Organisation Guidelines: a standard operating procedure. International Journal of Stroke 2015;10(SA100):128-35. [DOI: 10.1111/ijs.12583] - DOI - PubMed
Gupta 2016
    1. Gupta D, Hull ML, Fraser I, Miller L, Bossuyt PMM, Johnson N, et al. Endometrial biomarkers for the non-invasive diagnosis ofendometriosis. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No: CD012165. [DOI: 10.1002/14651858.CD012165] - DOI - PMC - PubMed
Intercollegiate Stroke Working Party 2012
    1. Intercollegiate Stroke Working Party. National Sentinel Stroke Clinical Audit 2010. Royal College of Physicians, 2012.
Intercollegiate Stroke Working Party 2016
    1. Intercollegiate Stroke Working Party. Intercollegiate Stroke Working Party National Clinical Guideline for Stroke. 5th edition. London: Royal College of Physicians, 2016.
International Dysphagia Diet Std Initiative 2017
    1. International Dysphagia Diet Standardisation Initiative. Complete IDDSI Framework Detailed definitions. 2017. https://iddsi.org/framework/. [http://iddsi.org/framework/]
Jiang 2016
    1. Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: a systematic review. Ci Ji Yi Xue Za Zhi 2016;28(2):41-8. [DOI: 10.1016/j.tcmj.2016.04.006] - DOI - PMC - PubMed
Johnson 2019
    1. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology 2019;18(5):439-58. - PMC - PubMed
Katan 2018
    1. Katan M, Luft A. Global burden of stroke. Seminars in Neurology 2018;38(2):208-11. - PubMed
Kumar 2010
    1. Kumar S, Selim MH, Caplan LR. Medical complications after stroke. Lancet Neurology 2010;9:105-18. - PubMed
Martino 2005
    1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36(12):2756-63. - PubMed
National Stroke Foundation 2010
    1. National Stroke Foundation. Clinical guidelines for stroke management, 2010. https://extranet.who.int/ncdccs/Data/AUS_D1_Clinical%20Guidelines%20for%....
O'Horo 2015
    1. O’Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside diagnosis of dysphagia: a systematic review. Journal of Hospital Medicine 2015;10(4):256-65. - PMC - PubMed
Oliveira 2001
    1. Oliveira I, Mota L, Freitas S, Ferreira P. Dysphagia screening tools for acute stroke patients available for nurses: a systematic review. Nursing Practice Today 2019;6(3):103-15. [DOI: 10.18502/npt.v6i3.1253] - DOI
Powers 2019
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al, on behalf of the American Heart Association Stroke Council. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344–e418. [DOI: 10.1161/STR.0000000000000211] - DOI - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre, the Cochrane Collaboration Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2014.
Rofes 2011
    1. Rofes L, Arreola V, Almirall J. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology Research and Practice 2011;2011:13. - PMC - PubMed
Schepp 2012
    1. Schepp K, Tirschwell DL, Miller RM, Longstreth WT Jr. Swallowing screens after acute stroke: a systematic review. Stroke 2012;43(3):869-71. - PMC - PubMed
Teasell 2019
    1. Teasell R, Salbach NM, Acerra N, Bastasi D, Carter SL, Fung J, et al, on behalf of the Rehabilitation and Recovery following Stroke Writing Group. Assessment and Management of Dysphagia and Malnutrition following Stroke. In Lindsay MP, Mountain A, Gubitz G, Dowlatshahi D, Casaubon L, de Jong A, Smith EE (Editors); on behalf of the Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations 2019:71-5.
WHF 2016
    1. World Heart Federation. The global burden of stroke, 2016. www.world-heart-federation.org/cardiovascular-health/stroke/.

References to other published versions of this review

Boaden 2017
    1. Boaden E, Doran D, Burnell J, Clegg A, Dey P, Hurley M, et al. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No: CD012679. [DOI: 10.1002/14651858.CD012679] - DOI - PMC - PubMed