Table 1.

Summary of published clinical swallowing evaluation protocols and screening tools with reference to first author, patient population validated against, protocol items, and test sensitivity and specificity for detecting swallowing impairment and/or aspiration (as specified)

First author year	Protocol	Administrator	Patient population Number of participants (N) Validation instrument utilized	Summary of protocol items	Sensitivity: Swallow safetya Dysphagiab	Specificity: Swallow safetya Dysphagiab	Volitional cough test included?
Martino et al. (2009) [53]	The toronto bedside swallowing screening test (TOR-BSST)	Nurse speech- language pathologist	Inpatient stroke: Acute*; Rehabilitation** (N = 311) VFSS	Kidd 50 cc water swallow test; tongue movement; general dysphonia; voice quality before and after 50 mL liquid trial	Dysphagiab 91.3 %	Dysphagiab 66.7 %	No
Mann (2002) [51]	Mann assessment of swallowing ability (MASA)	Speech-language pathologist	Acute stroke VFSS	Ratings across the following items: Alertness; cooperation; auditory comprehension; respiration; respiratory rate during swallowing; dysphasia, dyspraxia; dysarthria; saliva; lip seal; tongue movement/strength/co-ordination; gag; palate; voluntary cough; reflexive cough during swallowing; voice; tracheotomy; pharyngeal response; diet recommendations; fluid recommendations	Aspirationa 93 %	Aspirationa 63 %	Yes
Antonios et al. (2010) [52]	Modified mann assessment of swallowing ability (MMASA)	Physician Neurologist 1 Neurologist 2	Acute stroke* (N = 150) Comprehensive clinical assessment based on MASA	Items rated? 1–12: alertness; cooperation; respiration; expressive dysphagia; auditory comprehension; dysarthria; saliva; tongue movement; tongue strength; gag; voluntary cough; palatal movements	Dysphagia (N 1) 92 % (N 1) 87 %	Dysphagia (N 1) 86 % (N 1) 84 %	Yes
Trapl et al. (2007) [55]	Gugging swallowing screen (GUSS)	Speech-language pathologist (Gp 1) Nurse (Gp 2)	Acute stroke* (N = 50) Group 1 n = 20 Group 2 n = 30 FEES	Indirect swallow test: laryngeal elevation; saliva swallow; vigilance; voluntary cough; throat clearing Direct swallow test: six ½ tsp. puree, 3, 5, 10, 20, 50 cc thin liquid, small piece dry bread ×5 trials	Aspirationa PAS = 4 and/or 5 Group 1: 100 % Group 2:100 %	Aspirationa PAS = 4 and/or 5 Group 1: 50 % Group 2: 69 %	Yes
Edmiaston et al. (2010) [50]	Acute stroke dysphagia screen (ASDS)	Nurse	Acute stroke* (N = 300) MASA	Glasgow Coma Scale; facial asymmetry; weakness of the face/tongue/palate; 3 oz. water swallow test	Aspirationa 95 %	Aspirationa 68 %	No
Edmiaston et al. (2014) [49]	Barnes-jewish hospital Stroke dysphagia Screen (BJH-SDS)	Nurse	Acute stroke* (N = 225) VFSS	Glasgow coma scale; asymmetry; weakness; face/tongue/palate function; 3 oz. water swallow	Aspirationa 95 % Dysphagia 91 %	Aspirationa 50 % Dysphagia 74 %	No
Hinds and wiles (1998) [54]	Timed swallow test	Physician	Acute stroke* (N = 93)	Swallow questionnaire; 5–10 cc and 100–150 cc thin liquids serial timed swallowing trials	Not assessed	Not assessed	No
Logemann et al. (1999) [58]	Northwestern dysphagia Patient check sheet	Not specified	Heterogeneous*** (N = 200) VFSS	Medical history; behavioral variables; gross motor function; oral motor exam; swallow trials of: 1 cc thin, 1 cc pudding, ¼ Lorna Doone cookie	Aspirationa & Dysphagia Reported for 28 individual items	Aspirationa & Dysphagia Reported for 28 individual items	Yes
Suiter and Leder (2008) [59]	3-oz. Water Swallow test (WST)	Speech-Language Pathologist	Heterogeneous*** (N = 3000) FEES	90 cc sequential liquid swallow trial. Fail: cannot complete, wet vocal quality, cough/throat clear within one minute after completion	Aspirationa 96.5 %	Aspirationa 48.7 %	No
Suiter et al. (2014) [56]	Yale swallow protocol	Speech-language Pathologist	Heterogeneous*** (N = 25) VFSS	Cognitive screen; brief oral mechanism examination and liquid swallow trial of 90 cc of water. Patient instructed to drink continuously without stopping	Aspirationa 100 %	Aspirationa 64 %	No
Clave et al. (2008) [57]	Volume-viscosity Swallow test (V-VST)	Speech swallow therapist	Heterogeneous*** Control N = 12 Patients N = 85 VFSS	Swallow trials including 5, 10, and 20 cc of nectar thick liquid, thin liquid, and pudding.	Penetration 83.7 % Aspiration 100 %	Penetration 64.7 % Aspiration 28.8 %	No

cc cubic centimeter; FEES fiberoptic endoscopic evaluation of swallowing; mL milliliter; oz.ounce; VFSS: videofluoroscopic swallow study

^*Acute stroke defined as patients admitted to hospital immediately following a stroke;

^**Rehabilitation stroke is defined as Patients in a sub-acute rehabilitation facility following stroke;

^***Heterogeneous population by author includes the following: Logemann [58]: single stroke, multiple strokes, head and neck cancer, spinal cord injury, other; Suiter [59]: cardiothoracic surgery, esophageal surgery, head and neck surgery, neurosurgery, medical, pulmonary, cancer, other, left stroke, right stroke, brainstem stroke, Parkinson’s disease, dementia, other neurological; Suiter [56]: esophageal surgery, head and neck cancer, neurosurgery, medical, neurological (stroke, multiple sclerosis, traumatic brain injury); Clave [57]: cerebrovascular disease, chronic pneumopathy, diabetes, geriatric diseases, neurodegenerative diseases (amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, Duchenne muscular dystrophy, and other), Zenker’s diverticulum, cricopharyngeal bar, post surgical, and tracheotomy

^aSwallow Safety: Sensitivity and specify outcome measures in reference to swallow safety status and the presence of penetration or aspiration

^bDysphagia: Outcome measures in reference to the presence or absence of general swallowing impairment (dysphagia)