Predictive value of a novel pragmatic tool for post-stroke aspiration risk: The Functional Bedside Aspiration Screen

There is still a strong need for an optimal clinician-friendly screening tool for the identification of aspiration risk in stroke patients. In this study, we present the development of a novel, context-specific screening tool for the prediction of aspiration risk on recent stroke survivors, the Functional Bedside Aspiration Screen (FBAS), and examine its construct validity, reliability with the predictive values toward pragmatic patients' outcomes.

We conducted a prospective validation study of 104 acute ischemic stroke patients admitted to clinical wards in a tertiary university hospital. A group of experts developed and administered the FBAS 10-point scale to all patients. Outcome measures were compared with those of the validated Yale Swallow Protocol (YSP, reference measure) and health indicators.

A strong association was found between the FBAS cutoff criterion and the YSP (Pearson χ²  = 54.92, P < .001). A score of ≤8 on the FBAS presented with 93.3% sensitivity and 83.3% specificity in deeming patient with reduced safety for oral nutrition (AUC = 0.934, CI = 0.884-0.985). An inverse relationship was found between performance on the FBAS and in-hospital and long-term outcome indicators. Patients who failed the FBAS were 1.82 times more likely to develop aspiration pneumonia (95% CI = 1.42-2.35) and 1.35 times more likely to develop pneumonia within 3 months postonset (95% CI = 1.15-1.59).

The FBAS is a potentially useful tool for timely prediction of aspiration risk and health outcome in acute stroke.