As per the Scottish Stroke Standards, Bill has had his swallow screen within 4 hours of admission to hospital, and is deemed safe to eat and drink. Later in the day, however, there are signs that Bill’s swallow has deteriorated. You are concerned that his swallow may now not be safe.
The swallow screening test is not sensitive enough to pick up every swallowing impairment. Aspiration is when the food or fluids enters the airway below the level of the vocal cords. It is important to closely monitor the patient when they resume eating and drinking and monitor for signs of aspiration/deterioration in chest status.
Drinking water without coughing is a sure sign that Bill is swallowing safely – this is not reliable. To increase the sensitivity of the test other factors should be taken into consideration e.g. conscious level, postural control, control of secretions, voluntary cough response and voice quality.
Bill’s wet gurgly voice is an indication that he is at risk of aspiration – the cough may be absent or very weak.
Bill’s ability to cough could be affected by a stroke – this is an indication that the patient is at high risk of aspiration.
Silent aspiration is when a patient aspirates without an outward sign such as a cough – up to 68% of those who aspirate, do so without coughing.
If a patient coughs they are aspirating – the cough maybe preventing the patient aspirating but may suggest the swallow is impaired.
The water swallow test is the most important part of the swallow screening procedure – signs and symptoms of dysphagia can be identified without the water swallow test. You should only proceed to the water swallow test if there are no other significant risk factors for dysphagia identified.
Page last reviewed: 29 Apr 2021
