A Validated Swallow Screener for Dysphagia and Aspiration in Patients with Stroke Anit Behera, PhD,* , † , ‡ , § Dana Read, MS, CCC-SLP, CBIS,* , † , ‡ , § Nancy Jackson, MSN, RN, CNRN, SCRN,* , † , ‡ , § Bashar Saour, MD,* , † , ‡ , § Dana Alshekhlee,* , † , ‡ , § and Amy K. Mosier, MS, CCC-SLP* , † , ‡ , § Background: Early detection of dysphagia is critical to reducing hospital complica- tions and length of stay in patients with various types of strokes. The aim of this study was to develop and evaluate the DePaul Hospital Swallow Screener (DHSS) tool to assess for dysphagia in patients with stroke. Methods: This prospective ob- servational study investigated patients admitted to a comprehensive stroke center. The DHSS is composed of a questionnaire containing 8 nonswallow items and a water swallow test. All patients admitted under a standard stroke protocol are screened by the nursing staff using the DHSS and then objectively evaluated by a speech- language pathologist using the Mann Assessment of Swallowing Ability (MASA). Validity measures and reliability through Cohen’s κ-coefficient with associated 95% confidence intervals were calculated. Results: A total of 224 patients completed the DHSS and had at least 1 MASA score. The overall Content Validity Index score for the DHSS was .92. Compared with the MASA dysphagia cutoff value, the DHSS had a specificity of 93% and a sensitivity of 69%, and compared with the MASA aspiration risk cutoff value, the DHSS had a specificity of 90% and a sensitivity of 70%. Stratified analysis for those with any documented stroke (ischemic or hem- orrhagic) compared with those admitted with transient ischemic attack or no stroke yielded similar sensitivity and specificity in both dysphagia and aspiration risk. Conclusion: The DHSS is a valid and reliable swallow screening tool with mod- erate agreement, high specificity, and reliable predictive values when compared with the MASA. Key Words: Dysphagia—questionnaire—aspiration—nursing. © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. Introduction According to the American Stroke Association, stroke is the leading neurological cause of dysphagia or diffi- culty in swallowing. 1 Dysphagia after stroke may occur in 42%-67% of patients within the first 3 days. 1,2 Early detection and treatment of dysphagia and/or risk of as- piration is critical in improving swallowing function during a patient’s hospital course. Aspiration pneumonia, a severe risk of undiagnosed or untreated aspiration, can com- promise the patient’s health and increase morbidity, hospital costs, and length of stay. 3-5 The American Stroke Asso- ciation and other societies such as the American Speech- Language-Hearing Association and the Veteran’s Health Administration recommend screening for dysphagia in patients with stroke prior to oral consumption of food, liquid, and/or medications. 6 Therefore, a swallow screen is an essential step in the management of stroke pa- tients and to assist in predicting dysphagia and determining the immediate risk of aspiration. 7 Early detection of From the *Center for Health Outcomes Research, Saint Louis Uni- versity, Saint Louis, Missouri; †SSM HEALTH Rehabilitation Network, Saint Louis, Missouri; ‡SSM HEALTH DePaul Hospital, Saint Louis, Missouri; and §Neurology Department, Saint Louis University, Saint Louis, Missouri. Received June 23, 2017; accepted February 15, 2018. Address correspondence to Amy K. Mosier, MS, CCC-SLP, 1027 Bellevue Avenue Suite 142, St. Louis, MO 63117. E-mail: akmosier@ ssm-select.com. 1052-3057/$ - see front matter © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.037 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2018: pp ■■–■■ 1