Sapienza global bedside evaluation of swallowing after stroke the globe-3s study

Background and purpose Dysphagia occurs in up to 50% of all acute stroke patients. There is debate regarding which is the most effective screening tool in identifying aspiration in acute stroke patients. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke (GLOBE‐3S), which combines the TOR‐BSST© with oxygen desaturation and laryngeal elevation measuring during swallowing. Methods We prospectively enrolled consecutive stroke patients within 72 hours of symptom onset. All stroke patients firstly underwent a standard neurological examination, then the GLOBE‐3S evaluation, and finally the fiberoptic endoscopic evaluation of swallowing (FEES). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and to each other's respective evaluation, administered the GLOBE‐3S and the FEES examination. We assessed the accuracy of the GLOBE‐3S in detecting post‐stroke swallow impairment with aspiration using the FEES as the standard. Results We enrolled 50 acute stroke patients, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. 33 patients (66%) failed the GLOBE‐3S evaluation; the GLOBE‐3S reached a sensitivity of 100% and a specificity of 77.3% (95% CI, negative predictive value: 100%, positive likelihood ratio: 4.34). The median time required for the GLOBE‐3S to be performed was 297 seconds. Conclusion GLOBE‐3S is quick to perform at bedside and can accurately identify aspiration in acute stroke patients. By including the measurement of laryngeal elevation and the monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.