Validation of the Yale Swallow Protocol in Post-Acute Care: A Prospective, Double-Blind, Multirater Study

Abstract

Purpose A systematic approach to the diagnosis and treatment of swallowing disorders relies heavily on valid and reliable screening protocols that provide clinicians with clear and objective information. The Yale Swallow Protocol (YSP) has been shown to be a useful, valid, and reliable screening tool for aspiration risk in the acute care setting. However, the YSP was not validated for use in post-acute care. This study evaluated the clinical utility of the YSP in the post-acute care setting. Method This prospective, double-blind, multirater study included a referred sample of 240 individuals, with varying medical diagnoses, who completed the YSP and an endoscopic evaluation of swallowing. Results Sensitivity for the YSP was 95.4%, specificity was 66.9%, positive predictive value was 77.6%, and negative predictive value was 92.4%. Conclusions The data from this prospective study appear to support the use of the YSP in post-acute care due to the ability to use the protocol on virtually all patients—regardless of diagnosis—and its high sensitivity and negative predictive value.

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

“…The Yale swallow protocol was utilized as a screening tool for aspiration risk. While it neglects to examine the physiology and structure of oropharyngeal swallowing musculature, the Yale swallow protocol has demonstrated sensitivity of 95.4% and specificity of 66.9% of detecting aspiration 28 . Higher V50Gy and 60Gy to the pharyngeal constrictor muscles and supraglottic larynx in our study were predictive of clinical aspiration.…”

“…The Yale swallow protocol, previously known as the 3‐ounce water swallowing test (3‐WST), is a screening test for aspiration, 25–27 recently validated in the subacute setting with FEES 28 . It was conducted at each of the study assessment time points.…”

Phase angle and overhydration are associated with post‐extubating dysphagia in patients with COVID‐19 discharged from the ICU

“…At extubation time, the Yale Swallow Protocol was performed. 13 The criteria for success were uninterrupted drinking (assisted or independent) of 89 ml of water from a cup without coughing. Criteria for failure were inability to drink the entire amount, interrupted drinking, or coughing during or immediately after drinking.…”

Oropharyngeal Dysphagia in Older Patients

“…Without being prescriptive, we note that the EAT-10 is a self-reported questionnaire and quick, easy screening method, validated to identify individuals at risk for dysphagia (https://www.nestlenutrition-institute.org/resources/nutrition-tools/details/ swallowing-assessment-tool) [23]. Similarly, the Yale Swallow Protocol [24] is an another evidence-based protocol that identifies aspiration risk that local teams may wish to consider. This tool supports recommendation of specific oral diets without the need for further instrumental evaluation; it is easily administered, reliable and validated for use in a variety of environments, including acute care, rehabilitation and nursing homes [24,25].…”

“…Similarly, the Yale Swallow Protocol [24] is an another evidence-based protocol that identifies aspiration risk that local teams may wish to consider. This tool supports recommendation of specific oral diets without the need for further instrumental evaluation; it is easily administered, reliable and validated for use in a variety of environments, including acute care, rehabilitation and nursing homes [24,25].…”