The Toronto Bedside Swallowing Screening Test (TOR-BSST)

• DOI: 10.1161/strokeaha.107.510370
• Publication Date: 2008-12-13T01:58:40Z
• Authors: Rosemary Martino; Frank Silver; Robert Teasell; Mark Bayley; Gordon Nicholson; David L. Streiner; Nicholas E. Diamant
• Keywords: Male; Point-of-Care Systems; Reproducibility of Results; Middle Aged; Deglutition; 3. Good health; Stroke; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Predictive Value of Tests; Data Interpretation, Statistical; Humans; Female; Deglutition Disorders; Algorithms; Aged

Background and Purpose—

Dysphagia occurs in 55% of all acute stroke patients. Early identification of dysphagia from screening can lead to earlier treatments and thereby reduce complications. We designed and validated a new bedside dysphagia screening tool—the Toronto Bedside Swallowing Screening Test (TOR-BSST) for stroke survivors in acute and rehabilitative settings.

Methods—

The TOR-BSST initially contained 5 items with proven high predictive ability for dysphagia. Trained screeners administer and score the TOR-BSST in less than 10 minutes. Trained nurses from 2 acute and 2 rehabilitation facilities administered the TOR-BSST to consecutively admitted stroke inpatients. A positive screen identified patients at risk for dysphagia. Blinded repeat screenings were conducted within 24 hours. Test-retest reliability was established with the first 50 administrations at an ICC=0.92 (CI, 0.85 to 0.96). Items were eliminated if they contributed ≤5% to the total score and were judged clinically impractical. 20% of all enrolled patients were randomly allocated to gold standard videofluoroscopic assessment of swallowing and findings rated independently by 4 blinded experts. Adequate validity was set at sensitivity ≥90% and negative predictive value ≥90%.

Results—

311 stroke inpatients were enrolled; 103 acute and 208 rehabilitation. Screening was positive in 59.2% acute and 38.5% rehabilitation patients. The pharyngeal sensation item did not meet inclusion criteria and was eliminated. The TOR-BSST demonstrated excellent validity with sensitivity at 91.3% (CI, 71.9 to 98.7), and negative predictive values at 93.3% in acute and 89.5% in rehabilitation settings.

Conclusion—

The TOR-BSST is a simple accurate tool to identify stroke patients with dysphagia regardless of severity and setting.