Feasibility and criterion validity of The Holistic and Reliable Oral Assessment Tool (THROAT) in acute dysphagic stroke patients

Introduction: Aspiration of oral bacteria is a biologically plausible mechanism in the development of stroke-associated pneumonia (SAP). There are no validated nursing assessment tools for oral health in stroke care or oral hygiene intervention trials. The Holistic and Reliable Oral Assessment Tool (THROAT) has been developed for use in older hospitalised patients and may have value in acute stroke patients. We evaluated the feasibility and concurrent validity of THROAT compared to a detailed dental examination in dysphagic acute stroke patients.Aims: To assess the feasibility and concurrent validity of a nurse-assessed oral assessment tool (THROAT) compared to a detailed dental examination in dysphagic acute stroke patients. A secondary aim was to assess the predictive validity of the tool for SAP. Method: A prospective, single-centre cohort observational design based at Salford Royal Foundation Trust. Patients within 24 hour of acute stroke onset, who were nil-by-mouth and expected to remain on the stroke unit >72 hours were screened for inclusion. THROAT was recorded by a research nurse, and a blinded dental care professional undertook a detailed dental examination, both within 24 hours of stroke symptom onset. Follow up every 48 hours until day 10 post-stroke was undertaken to determine acquisition of SAP.Results: Of 51 eligible patients approached, 33 (65%) consented to participate with one withdrawal (n=32, median age 79y; 56% women; median NIH stroke scale score=10.5). Both oral examinations were successfully completed and well tolerated in all participants. The mean time to complete THROAT was 2.1 minutes, and 5.3 minutes for the dental examination. Correlation between the individual components of THROAT and the dental examination was generally poor, although there was a modest correlation (r=0.48, p=0.00519) between the ‘Teeth/Denture’ score of THROAT and ‘percentage of teeth with ≥1 site with plaque present’ from the dental examination. 6 patients were diagnosed with SAP (18.8%); those with SAP were significantly associated, p