Three Tests for Predicting Aspiration without Videofluorography

Abstract

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium). Sixty-three individuals with dysphagia were each evaluated with the three non-VFG tests and a VFSS; 29 patients aspirated on the VFSS. The summed scores of all three non-VFG tests had a sensitivity of 90% for predicting aspiration and specificity of 71% for predicting its absence. The summed scores of the water and food tests (without X-ray) had a sensitivity of 90% and specificity of 56%. These non-VFG tests have limitations but may be useful for assessing patients when VFSS is not feasible. They may also be useful as screening procedures to determine which dysphagia patients need a VFSS.

Differences in the Peak Cough Flow among Stroke Patients With and Without Dysphagia

“…The summed scores of the PST and WST had a sensitivity of 90% and a specificity of 56%. The sensitivity of RSST was previously reported to be 98%, and it had the advantage of being simple, safe and inexpensive [8]. The high sensitivity of these non-VFG tests means that they have a low rate of false negatives, so we suspected dysphagia if the results of any one of these tests was judged to be abnormal, or if coughing occurred during swallowing, if there was difficulty with eating, if there was wet hoarse dysphonia after deglutition, or if the subject had a past history of suffocation, we suspected dysphagia.…”

Evolução da deglutição no pós-AVC agudo: estudo descritivo

“…Dysphagia is associated with impaired food intake, which can lead to malnutrition during hospital stay and to pulmonary complications, especially pneumonia by aspiration [3][4][5][6][7] . In addition, it also has potential impact on emotional aspects of food, as it can lead to withdrawal and isolation of the patients, compromising their quality of life 6 .…”

“…The initial speech evaluation and prophylactic and therapeutic interventions in acute stroke patients are able to reduce the rates of dysphagia-related complications 1,[7][8][9][10] .…”

Protocolo fonoaudiológico de introdução e transição da alimentação por via oral para pacientes com risco para disfagia (PITA)

“…Tipicamente, o estetoscópio é posicionado na região cervical acima da cartilagem cricóide, a frente do músculo esternocleidomastoideo e dos grandes vasos (Tohara et al, 2003;Leslie et al, 2007;Borr et al, 2007).…”

“…A incoordenação entre a deglutição e a respiração aumenta o risco de aspiração em pacientes taquipneicos ou dispneicos, pois estes podem não ser capazes de tolerar períodos maiores ou mesmo curtos de apnéia durante a deglutição (Goldsmith, 2000;Tohara et al, 2003;Masiero et al, 2008).…”