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Screening for Swallowing Problems in Patients Following Prolonged Intubation: Validation of the Toronto Bedside Swallowing Screening Test (TOR-BSST©)

This study has been completed.
Canadian Institutes of Health Research (CIHR)
Information provided by (Responsible Party):
University Health Network, Toronto Identifier:
First received: August 4, 2011
Last updated: October 27, 2016
Last verified: October 2016
Despite medical advances, half of the patients admitted to hospital for recovery from acute illness, injury or surgery have swallowing difficulties and those requiring tubes for breathing support are at even greater risk. Difficulties with swallowing decrease patients' quality of life, prolong their hospital stay, as well as lead to medical complications such as pneumonia, malnutrition and death. Presently, there is no screening test for swallowing difficulties in patients who have required respiratory support. Screening will allow for early detection of swallowing problems which is important to prevent serious complications, such as pneumonia. This research will determine the accuracy of a new screening test, the Toronto Bedside Swallowing Screening Test (TOR-BSST©) previously tested with stroke patients, to predict the presence of swallowing difficulties in patients who have required breathing support for longer than 48 hours. The investigators will enroll 100 patients from the intensive care medical surgical units at the University Health Network. The findings from this research will help identify those patients with swallowing problems earlier than it is currently possible. Once identified, at risk patients will be referred to a speech language pathologist swallowing expert for more comprehensive testing; thereby, decreasing their risk of experiencing serious complications, such as pneumonia, secondary to swallowing problems.

Condition Intervention
Other: Toronto Bedside Swallowing Screening Test (TOR-BSST©)
Procedure: Videofluoroscopic Swallow Study

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective

Resource links provided by NLM:

Further study details as provided by University Health Network, Toronto:

Primary Outcome Measures:
  • Validity of the TOR-BSST© [ Time Frame: 24 hours ]
    The validity of the TOR-BSST© will be measured using sensitivity, specificity, likelihood ratios, positive predictive value (PPV), and negative predictive value (NPV). Results of the videofluoroscopic assessment of swallowing will be used as the gold standard comparison.

  • Inter-rater reliability of the TOR-BSST© [ Time Frame: 24 hours ]
    Inter-rater reliability will be calculated using the intraclass correlation coefficient (ICC).

Secondary Outcome Measures:
  • Estimation of the incidence of dysphagia in adult acute patients following prolonged intubation [ Time Frame: 24 hours ]
  • Description of the impairment characteristics of dysphagia in adult acute patients following prolonged intubation [ Time Frame: 24 hours ]

Enrollment: 100
Study Start Date: May 2011
Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Med/Surg ICU Inpatients, Intubated ≥ 48 hours Other: Toronto Bedside Swallowing Screening Test (TOR-BSST©)
All enrolled patients will be screened for dysphagia by two blinded screeners using the TOR-BSST©.
Procedure: Videofluoroscopic Swallow Study
All enrolled patients will undergo a videofluoroscopic assessment of swallowing within 24 hours of being screened with the TOR-BSST©.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Med/Surg ICU inpatients who have received endotracheal intubation lasting 48 hours or longer

Inclusion Criteria:

  • Adults 18+ years
  • Inpatient at University Health Network, in any of the medical-surgical intensive care units, regardless of disease type, comorbidities or previous medical history
  • Received endotracheal intubation lasting 48 hours or longer

Exclusion Criteria:

  • History of one or more of the following: neurological disorder, surgery to the head or neck, previous oropharyngeal dysphagia, tracheotomy in situ or dementia
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Please refer to this study by its identifier: NCT01411306

Canada, Ontario
University Health Network
Toronto, Ontario, Canada, M5G 2C4
Sponsors and Collaborators
University Health Network, Toronto
Canadian Institutes of Health Research (CIHR)
Principal Investigator: Rosemary Martino, PhD University of Toronto / University Health Network