Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012.

D ysphagia screening is a recurring topic of discussion in stroke care and other acute and chronic conditions that can affect swallowing. Many would agree with Wolf and Rudd that " [s]wallowing screening is so obviously important that a trial is not needed, but the hard evidence that screening saves lives is absent. " 1 Paradoxically, the 2010 Joint Commission retired the dysphagia screening performance standard for acute stroke because the National Quality Forum could not endorse it, stating that there are no standards for what constitutes a valid dysphagia screening tool, and no clinical trials have been completed that identify the optimal swallow screening. 2 Consequently, dysphagia screening was removed from the " Get With The Guidelines " stroke guidelines. This has led to concern among multidisciplinary stroke professionals that dysphagia screening will be entirely omitted from stroke care, leading to worsening outcomes among stroke patients at risk for swallowing problems. An invita-tional symposium was held January 31, 2012, at the State-of-the-Art Nursing Symposium in New Orleans, LA, to explore the issues and state of the science in dysphagia screening. The present report serves as a conference proceeding that aims to (1) educate multidisciplinary stroke professionals about the important issues related to identifying valid and reliable dysphagia screening tools, (2) identify the strengths and limitations of currently available dysphagia screenings, (3) describe how facilities may make cogent decisions about dysphagia screening selection, based on their specific needs, and (4) provide an example for establishing a dysphagia screening in a stroke care unit. As part of the discussion during the symposium, several expert recommendations were made regarding dysphagia screening in stroke care, which are also presented here. We will begin the report, as we will end, with this caveat: Because dysphagia screening is not a " one size fits all " process, neither the symposium nor the present report aimed to suggest that a single tool will meet the needs of multidisciplinary stroke professionals at every level of stroke care. Stroke is the leading neurological cause of dysphagia (difficulty swallowing), with 42% to 67% of patients presenting with dysphagia within 3 days of stroke. Fifty percent of these patients aspirate, and one third of patients who aspirate develop pneumonia that requires treatment. 3 In addition, swallowing abnormality is associated with a 3-fold higher mortality rate, largely attributable to pneumonia. Early identification of dysphagia and aspiration risk is critical to avoid …