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Dysphagia screening post-stroke: systematic review
  1. Stefano Mancin1,2,3,
  2. Marco Sguanci4,
  3. Francesco Reggiani2,5,
  4. Emanuela Morenghi2,6,
  5. Michela Piredda4 and
  6. Maria Grazia De Marinis4,7
  1. 1 Nutrition Unit, Cancer Center, IRCCS Humanitas Research Hospital, via Manzoni, 56 20089 Rozzano, Italy
  2. 2 Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
  3. 3 Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Viale Montpellier, 1- 00128 Rome, Italy
  4. 4 Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
  5. 5 Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
  6. 6 Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
  7. 7 Fondazione Policlinico Universitario, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
  1. Correspondence to Michela Piredda, Research Unit Nursing Science, Universita Campus Bio-Medico di Roma, Rome, Via Alvaro del Portillo, 00128, Italy; M.Piredda{at}


Background/scope Stroke is one of the main causes of death, especially when associated with dysphagia. Hence, the assessment of nutritional status and aspiration risk is important to improve clinical outcomes. The aim of this systematic review is to identify which are the most suitable dysphagia screening tools in chronic post-stroke patients.

Methodology A systematic literature search was conducted for articles published from 1 January 2000 to 30 November 2022 in the Cochrane Library, PubMed, Embase, CINAHL, Scopus and Web of Science databases, including primary studies providing quantitative or qualitative data. Additionally, a manual search was conducted scanning the reference lists of relevant articles and Google Scholar was searched to retrieve additional records. The process of screening, selection and inclusion of the articles, as well as the assessment of risk of bias and methodological quality, were conducted by two reviewers.

Results Out of the 3672 records identified, we included 10 studies, mostly (n=9) cross-sectional, evaluating screening for dysphagia in 1653 chronic post-stroke patients. Volume-Viscosity Swallow Test was the only test applied in multiple studies with adequate sample size, demonstrating high diagnostic accuracy (sensitivity=96.6%–88.2%; specificity=83.3%–71.4%) compared with the videofluoroscopic swallowing study.

Conclusions Dysphagia is an important complication in chronic post-stroke patients. Early identification of this condition through screening tools with adequate diagnostic accuracy is of paramount importance. The limited number of studies available and their small sample sizes may be a limitation to this study.

PROSPERO registration number CRD42022372303.

  • Stroke
  • Dysphagia
  • Rehabilitation
  • Hospice care
  • Home care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Correction notice This article has been corrected since it was published online. In the section ‘Objectives of this review’, ‘flexible endoscopic evaluation of swallowing (FEES)’ has been added to the list of reference standards in the first sentence. In Table 1, in the row for Ward et al., 2020, ‘Long-term care’ has been amended to ‘Rehabilitation’ and ‘Clinicians (not specified)’ has been amended to ‘Speech language pathologists’. In the section ‘Healthcare professionals applying dysphagia screening tools’, citations of reference 34 have been removed from the first sentence. In Table 2, in the row for Ward et al., 2020, ‘VFSS’ has been amended to ‘FEES’, ‘Palliative care’ has been amended to ‘Rehabilitation’, and ‘FEES, flexible endoscopic evaluation of swallowing’ has been added to the table legend.

  • Contributors SM—conceptualisation, methodology, writing original draft, review and editing, investigation and visualisation. MS—review and editing, investigation and visualisation. FR—review and editing, and visualisation. EM—review and editing and statistical analysis. MP—conceptualisation, methodology, review and editing, and supervision. MGDM—conceptualisation, project administration, supervision and responsible for the overall content of the article. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.