Evaluating Swallowing Dysfunction Using a 100-ml Water Swallowing Test

Wu, M C; Chang, Yeun‐Chung; Wang, Tyng-Guey; Lin, Li‐Chan

doi:10.1007/s00455-003-0030-x

Cited by 121 publications

(81 citation statements)

References 14 publications

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“…58 The majority of studies were exclusively inpatient 7, 14, 17–19, 21, 22, 24–26, 31–33, 35, 36, 38, 39, 41, 43–47, 49, 51–53, 56, 57, 59 with five in mixed in and outpatient populations, 20, 27, 40, 55, 60 two in outpatient populations, 23, 42 and the remainder not reporting the setting from which they drew their study populations.…”

Section: Resultsmentioning

confidence: 99%

“…The indications for swallow evaluations fit broadly into four categories; stroke, 7, 14, 21, 22, 24–26, 31, 33–35, 38, 39, 41–44, 46, 49, 53, 56, 58, 59 other neurologic disorders, 17, 18, 23, 28, 40, 48 all causes, 16, 20, 27, 29, 30, 36, 37, 45, 47, 50, 52–55, 60 and post-surgical. 19, 32, 34 Most used VFSS as a reference standard, 7, 14, 16–19, 21–23, 25–30, 34, 36–48, 51–56, 58–60 with eight using FEEST, 20, 24, 31–33, 35, 50, 57 and one accepting either VSE or FEEST.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Bedside diagnosis of dysphagia: A systematic review

O’Horo

Rogus-Pulia

Garcia-Arguello

et al. 2015

Journal of Hospital Medicine

136

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Background Dysphagia is associated with aspiration, pneumonia and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. Methods We conducted a comprehensive search of seven databases, including MEDLINE, EMBASE and Scopus, from each database’s earliest inception through June 5th, 2013. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study [VFSS] or flexible endoscopic evaluation of swallowing with sensory testing [FEEST]) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design and prediction of aspiration. Results The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and one description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in post-stroke adults, limiting the generalizability of results. Conclusions No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Bedside diagnosis of dysphagia: A systematic review

O’Horo

Rogus-Pulia

Garcia-Arguello

et al. 2015

Journal of Hospital Medicine

136

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“…Thus, having subjects drink as fast as possible during a timed test and measuring the number of swallows required is reported to be an effective method of detecting dysphagia/difficulty in swallowing. With VF aspiration set as their end point, Wu et al [17] reported that clinical symptoms seen in a 100-ml WST achieved a sensitivity of 47.8% and a specificity of 91.7%, but the same values for a drinking speed WST were 85.5 and 50%, respectively. Nathadwarawala et al [35] considered those who drank slower than 10.7 ml/s to be abnormal, but the average drinking speed in our study was 3.4 ml/s, with no patients exceeding 10 ml/s.…”

Section: Discussionmentioning

confidence: 99%

“…However, if a mouthful is not large enough, then the swallowing/deglutition reflex is less likely to occur [9], so there are instances when a 30-ml WST is recommended [10]. In WSTs in the Western world, 10 ml [11], 50 ml [12,13,14], 3 oz (about 90 ml) [15,16], 100 ml [17], and 150 ml [18] are used. Safety is an important consideration, and many variables can be examined with a small amount of water.…”

Section: Introductionmentioning

confidence: 99%

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

2013

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Background and Purpose: The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. Methods: We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. Results: We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. Conclusions: WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.

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“…Because these procedures are technically demanding, the tendency in everyday practice is to try to obtain meaningful information on a patient’s swallowing ability by using standardised screening procedures. This is primarily achieved using swallow tests with water, modified in a variety of ways [1, 4, 6–9, 17]. …”

Section: Introductionmentioning

confidence: 99%

The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study

Schultheiss

Nusser-Müller-Busch

Seidl

2011

Eur Arch Otorhinolaryngol

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Contrary to clinical experience, clinical swallow tests are predominantly performed using water (water swallow tests, WST). In this study, we examine whether swallow tests performed using a bolus of semisolid food (bolus swallow test, BST) offer benefits. In a prospective, randomised, blind study, the results of a standardised saliva swallow test (SST), WST, BST, combinations of these tests and an endoscopic swallow test (FEES) in patients with oropharyngeal swallowing disorders of neurological (NEU) and non-neurological (NNEU) origin were compared. Sensitivity, specificity, test accuracy and inter-rater reliability were analysed. 62 patients (mean age = 64.68; range = 22–84) were included in the study (NEU = 40; NNEU = 22). A sensitivity of 70.7% (NEU = 70.3%, NNEU = 71.4%) and specificity of 82.5% (NEU = 92.3%; NNEU = 100%) were determined for the WST. The BST + SST was found to have a sensitivity of 89.6% (NEU = 66.7%; NNEU = 90.9%) and a specificity of 72.7% (NEU = 87.5%; NNEU = 90.9%). Analysis of test accuracy showed a statistically significant correlation between FEES and BST + SST. Only BST + SST exhibited statistically significant inter-rater reliability. BST in combination with SST was the sensitive clinical instrument for detecting aspiration both over the patient population as a whole and over the two sub-populations. Inter-rater reliability was found to be statistically significant. The results presented here demonstrate the benefit of semisolid food in investigating clinical dysphagia.

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Evaluating Swallowing Dysfunction Using a 100-ml Water Swallowing Test

Cited by 121 publications

References 14 publications

Bedside diagnosis of dysphagia: A systematic review

Bedside diagnosis of dysphagia: A systematic review

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study

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