Toronto Bedside Swallowing Screening Test (TOR-BSST©)

Purpose of the measure

The Toronto Bedside Swallowing Screening Test (TOR-BSST©) is a screening tool administered at the bedside by trained screeners which identifies patients at risk for dysphagia following stroke.

Available versions

There is one version of the TOR-BSST©. See https://swallowinglab.com/tor-bsst/.

Features of the measure

Items:
The TOR-BSST© is comprised of 5 items:

  1. Baseline vocal quality
  2. Tongue movement
  3. 50mL water test
  4. Cup sip
  5. Final judgment of vocal quality

Scoring:
The TOR-BSST© uses binary scoring (i.e. abnormal/normal) for each item. Failure on any item discontinues the screen and prompts referral to a Speech-Language Pathologist dysphagia expert.

What to consider before beginning:
The TOR-BSST© should only be used with patients who are alert, able to sit upright at 90 degrees, and are able to follow simple instructions. Patients who do not meet these guidelines should not be screened but, instead, be referred to a Speech-Language Pathologist for assessment.

International best practice guidelines advise that, following stroke, patients should undergo screening for swallowing difficulties before oral intake of food, fluids or oral medication. Screening should be performed by specially trained personnel, using a validated screening tool. Swallowing should be screened as soon as possible after admission provided that the patient is able to participate. Patients who fail the swallowing screening should be referred to a Speech-Language Pathologist for comprehensive swallowing assessment. For patients who are confirmed at high risk of aspiration and/or dysphagia should undergo an instrumental assessment such as videofluoroscopy swallowing study (VFS) and/or fibreoptic evaluation of swallowing (FEES).

Time:
The TOR-BSST© takes less than 10 minutes to administer and score. Administration ceases immediately on failure of an item.

Training requirements:
The TOR-BSST© can be administered by health professionals who have undergone the requisite 4-hour didactic standardized training program. Didactic training is followed by individual training/competency observations. Training is provided by Speech-Language Pathologists who have completed the “TOR-BSST© Training for the SLP Dysphagia Expert” trainers course.

See The Swallowing Lab (https://swallowinglab.com/tor-bsst/) for details.

Equipment:
The TOR-BSST© is a one-page double-sided form that includes standardized instructions for administration.

Client suitability

Can be used with:

The TOR-BSST© is suitable for use with individuals with stroke across the recovery continuum (Martino et al., 2009).

The TOR-BSST© is being validated for use with critically ill patients who have undergone prolonged intubation and may be at risk of swallowing problems.

Should not be used in:

Following stroke, patients should be assessed and managed according to best practice guidelines for dysphagia. The TOR-BSST© should not be used with individuals with decreased alertness or cognition, or those who are being tube-fed. Patients who are being tube-fed have already been identified to have dysphagia and therefore should be referred to a Speech-Language Pathologist for a comprehensive assessment and management.
 
In what languages is the screening tool available?
  • English
  • French
  • Chinese
  • German
  • Italian
  • Portuguese (Brazil)