Reduced incidence of aspiration with spoon-thick consistency in stroke patients.

BACKGROUND

Dysphagia and aspiration occur frequently in stroke patients. The aim of the present study was to evaluate 2 consistencies (liquid and spoon-thick/pudding-like) regarding the risk of aspiration and to determine the usefulness of a bedside speech therapy assessment to predict risk of aspiration.

METHODS

This randomized, crossover clinical trial was carried out April to August 2001 at a university hospital. Sixty-one inpatients diagnosed with acute phase or prior stroke received liquid and spoon-thick (pudding-like) feeds during nasoendoscopy and bedside clinical assessment.

RESULTS

Aspiration occurred in only 3 patients with the spoon-thick consistency vs 21 with the liquid consistency (relative risk=0.13; 95% confidence interval=0.04-0.39; P<.001). The bedside assessment had a sensitivity of 81% and a specificity of 70.8% to detect risk of aspiration.

CONCLUSIONS

The use of a spoon-thick consistency reduced the risk of aspiration compared with the liquid consistency. Clinical assessment was useful to predict aspiration, although the probability of dysphagia in the presence of a negative clinical assessment (29%) is a reason for concern.