Joundi et al262 determined that patients who failed dysphagia screening were older, had a higher rate of multiple comorbidities (including prior stroke and dementia), more often came from a long-term care facility, more often presented with weakness and speech deficits, had a lower level of consciousness, and had a higher stroke severity. Patients who failed dysphagia screening were more likely to develop pneumonia (13.1% versus 1.9%), to have more severe disability (52.4% versus 18.0%), and to be discharged to a long-term care institution (14.0% versus 4.3%). Early dysphagia screening can be effective to identify patients at higher risk for aspiration, which is associated with greater risk of pneumonia, even if dysphagia screening was not associated with reduced rates of pneumonia or improvements in death or disability when tested See Tables LVII and LVIII in online Data Supplement 1. An endoscopic evaluation is reasonable for those patients suspected of aspiration to verify the presence/absence of aspiration and to determine the physiological reasons for the dysphagia to guide the treatment plan. IIa B-NR Recommendation wording modified from 2016 Rehab Guidelines to match COR IIa stratifications. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. It is reasonable for dysphagia screening to be performed by a speech- language pathologist or other trained healthcare provider. IIa C-LD Recommendation reworded for clarity from 2016 Rehab Guidelines. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. It is not well established which instrument to choose for evaluation of swallowing with sensory testing, but the choice may be based on instrument availability or other considerations (ie, fiberoptic endoscopic evaluation of swallowing, videofluoroscopy, fiberoptic endoscopic evaluation with sensory testing). IIb C-LD Recommendation reworded for clarity from 2016 Rehab Guidelines. COR unchanged. 