Bedside Diagnosis of Dysphagia: A Systematic Review
Journal of Hospital Medicine
O'Horo, J. C., Rogus-Pulia, N., et al. (2015).
Journal of Hospital Medicine, 10(4), 256-265.
This systematic review and meta-analysis compares the diagnostic accuracy of various clinical bedside swallowing examinations to the gold standard of videofluoroscopy or flexible endoscopic evaluation of swallowing with sensory testing for identifying adults at risk for aspiration and dysphagia.
Not stated
Up to June 2014
Comparative studies
48
Seven studies examined the sensitivity and specificity of subjective assessments from speech-language pathologists and nurses to predict aspiration at bedside (i.e., clinical observation of trail swallows of varying bolus types and amounts). The authors concluded that "overall, subjective exams did not appear reliable in ruling out dysphagia" (p. 258).
Sixteen studies examined the use of multi-item protocols to screen and assess patients at risk for dysphagia. Protocols included various assessment items/measures (e.g., clinical history, assessment of oral-motor strength, assessment of sensation) used in combination to predict suspected dysphagia. Of these, two studies examined the use of the Barnes Jewish Stroke Dysphagia Screen and the Swallow-30 Acute Stroke Dysphagia Screen and reported that these protocols had "reasonable sensitivity and specificity in identifying dysphagia" in stroke populations (p. 258).
Three studies examined the use of bedside water swallow tests (e.g., 3oz water swallow test, 50ml water swallow trials) to identify patients at risk for aspiration. Overall sensitivity for correctly ruling patients in for aspiration ranged from 79% to 97%. Overall specificity for correctly ruling patients out for aspiration ranged from 30% to 63%.
<p>Four studies examined the use of patient-reported questionnaires to identify dysphagia symptoms and risk for aspiration. Questionnaires included:</p>
<ul>
<li>the EAT-10 Tool;</li>
<li>the Swallowing Disturbance Questionnaire;</li>
<li>the Dysphagia Questionnaire; and</li>
<li>the Swallow-30 Acute Stroke Dysphagia Screen</li>
</ul>
<p>Overall sensitivity for correctly ruling patients in for dysphagia ranged from 73% to 86%. Overall specificity for correctly ruling patients out for dysphagia ranged from 44% to 85%.</p>
Thirty studies examined the clinical utility of various bedside assessments used in isolation (e.g., assessment of dysphonia, trial swallows, oral-motor examination) to accurately predict aspiration. Swallowing methods reported to have adequate sensitivity/specificity were: the assessment of dysphonia, assessment of pharyngeal sensation, and assessment of abnormal pharyngeal swallow behavior with dual axis accelerometry.
