Clinical Utility of Swallowing Provocation Test and Water Swallowing Test in Stroke Patients

ABSTRACT

OBJECTIVE: To assess the clinical utility of the swallowing provocation test (SPT) and water swallowing test (WST) as a predictive factor of supraglottic penetration (SP) and subglottic aspiration (SA) in stroke patient with dysphagia. METHOD: Fourty-one patients suffered from ischemic stroke with dysphagia and 20 normal controls were recruited. We performed 2-step SPT (0.4 ml, 2.0 ml) via nasopharyngeal tube and 2-step WST (10 ml, 30 ml) per oral, combined with the videofluoroscopic swallowing study (VFSS) to determine the presence of SP and SA. RESULTS: The cutoff values of the swallowing provocation latency in SPT for the detection of SP and SA were 2.45 sec, 2.75 sec (first step) and 2.25 sec, 2.34 sec (second step). For SPT, the sensitivity and specificity were 78.8%, 64.3% (first step) and 71.4%, 77.8% (second step) for the SP, and 77.8%, 76.7% (first step) and 75.0%, 66.7% (second step) for the SA. For WST, the sensitivity and specificity were 66.7%, 90.9% (first step) and 70.0%, 90.9% (second step) for the SP, and 61.1%, 56.5% (first step) and 72.2%, 60.9% (second step) for the SA. CONCLUSION: SPT was more useful for the detection of SA than WST in stroke patient with dysphagia.