Objective: To systematically evaluate the value of different aspiration risk assessment tools for assessing aspiration risk in stroke patients with dysphagia.

Methods: The literatures to evaluate the risk of aspiration in stroke patients with swallowing disorders using different tools were searched from databases including CNKI, Wanfang Database, VIP, PubMed, Cochrane Library, and Web of Science from databases establishment until April 2024. The combined sensitivity, combined specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and area under the curve (AUC) of different tools for diagnosing aspiration were calculated comparing with the gold standard.

Results: A total of 17 eligible studies were included, mainly including four risk assessment tools for aspiration, namely Kubota water swallowing test (WST), standardized swallowing assessment (SSA), Toronto bedside swallowing screening test (TOR-BSST), and Gussing swallowing screen (GUSS). The Meta-analysis results showed that the combined sensitivity of WST was 0.57 (95% CI: 0.51-0.62, P＝0.006), combined specificity was 0.80 (95% CI: 0.74-0.85, P＝0.014), DOR was 5.94 (95% CI: 3.42-10.31, P＝0.153), and AUC was 0.75. The combined sensitivity of SSA was 0.87 (95% CI: 0.82-0.90, P＝0.124), combined specificity was 0.65 (95% CI: 0.59-0.71, P＝0.031), DOR was 11.88 (95% CI: 5.63-25.07, P=0.214), and AUC was 0.73. The combined sensitivity of TOR-BSST was 0.65 (95% CI: 0.56-0.74, P＝ 0.004), combined specificity was 0.70 (95% CI: 0.62-0.77, P＝0.000), DOR was 3.40 (95% CI: 2.06-5.62, P＝0.000), and AUC was 0.69. The combined sensitivity of GUSS was 0.96 (95% CI: 0.91-0.99, P＝0.425), combined specificity was 0.62 (95% CI: 0.52-0.71, P＝0.729), DOR was 34.71 (95% CI: 12.39-97.24, P＝0.893), and AUC was 0.92.

Conclusion: For the risk assessment of aspiration in stroke patients with swallowing disorders, WST, SSA, TOR-BSST and GUSS all have good diagnostic values, and GUSS has a higher comprehensive diagnostic efficiency.