Evaluation of a nurse-led swallowing risk assessment tool in care-home residents: a prospective diagnostic accuracy study.

PURPOSE: To develop and test a screening tool enabling care-home staff to identify residents with high-risk swallowing problems (dysphagia).

METHODS

The Nurse Dysphagia Screening Tool (NDST) was developed via an iterative, participatory process. A diagnostic evaluation study was performed in North-East of England care homes. We compared NDST with gold-standard speech and language therapist swallowing assessment risk category to derive sensitivity, specificity, and positive and negative predictive values.

RESULTS

One hundred and seventy two residents (101 women) were included from 14 care homes, mean age 82.1 years (SD 10.6). Residents known to SLT, or with Percutaneous Endoscopic Gastrostomy (PEG) were excluded. 18/172 (11%) had high-risk swallow by gold-standard assessment. NDST was completed successfully on all participants. Sensitivity, specificity, and positive and negative predictive values were 72%, 92%, 50%, and 97%, respectively. Sensitivity was higher (100%) in high-volume care homes and for those recruited late in the study, suggesting a learning curve.

CONCLUSION

NDST requires additional testing but can potentially identify high-risk dysphagia in care homes.