Does a 3-sip test detect dysphagia in acute stroke rehabilitation patients?

Objectives: (1) Evaluate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a 3-sip test within 24 hours of acute stroke as a screening for clinically relevant dysphagia during acute rehabilitation. (2) For those patients who pass the 3-sip test, identify factors predictive of later detection of clinically relevant dysphagia.

Design: A retrospective review.

Setting: Acute stroke rehabilitation unit of a tertiary academic medical center.

Patients: 223 patients undergoing dysphagia screening after stroke.

Main outcome measure: Development of clinically relevant dysphagia.

Results: Seventeen of 223 patients (7.6%) failed the 3-sip test. Of the 206 patients who passed the 3-sip test, 57 (27.7%) manifested clinically relevant dysphagia. Sensitivity and specificity of the 3-sip test were 20.8% and 98.7%, respectively. PPV and NPV were 88.2% and 72.3%, respectively. Among those who passed the 3-sip test, logistic regression identified the Functional Independence Measure (FIM) total score as the only independent predictor (B = -0.066, P < .001) of clinically relevant dysphagia. Of those patients who passed the 3-sip test, 54.6% with an FIM total score <60 had clinically relevant dysphagia compared with 11.9% with an FIM total score >60.

Conclusions: The sensitivity of the 3-sip test was poor for stroke rehabilitation patients. For those who passed the 3-sip test, a low FIM total score was predictive of development of clinically relevant dysphagia. A high degree of clinical suspicion for dysphagia should remain after passing a 3-sip screening test, especially for those with FIM total score <60.