Bedside Swallowing Screening Scores, Dementia, Disuse Syndrome and Recorded Choking in Hospitalised Patients: A Retrospective Cross-Sectional Study

Background/Objectives: Choking is a leading cause of unintentional death in older people. In hospital, patients who pass bedside swallowing screening are advanced to firmer food, yet the screening was validated against aspiration, not choking. We examined how recorded choking was related to screening scores and to the underlying disease. Methods: In this single-centre retrospective cross-sectional study, 2420 inpatients (mean age 82.6 years) referred to a Japanese general hospital for feeding and swallowing therapy between 2009 and 2026 who took an oral diet were analysed. Choking was examined by modified water swallowing test (MWST) and food test (FT) score, and in one logistic regression including the disease categories, with cerebrovascular disease as the reference, adjusted for age, sex, both scores and enteral and parenteral nutrition. Results: Choking was recorded in 75 patients (3.10%). A passing FT score (4 or 5) was recorded in 2172 patients (89.8%), who accounted for 72 of the 75 events (3.31%, versus 1.21% with scores of 1–3), and the proportion choking rose with both scores. Relative to cerebrovascular disease, dementia (adjusted odds ratio 3.77, 95% confidence interval 1.86–7.67) and disuse syndrome (3.09, 1.63–5.86) were associated with choking. Conclusions: Recorded choking occurred in patients with favourable screening scores, who may have received firmer food textures; however, the predictive performance of these tests for choking could not be established. Dementia and disuse syndrome were associated with choking independently of the scores, and caution may be warranted in these patients before food texture is advanced. These post hoc findings require prospective confirmation.