Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis
Chest
Brodsky, M. B., Suiter, D. M., et al. (2016).
Chest, 150(1), 148-163.
This systematic review and meta-analysis compares the diagnostic accuracy of bedside water swallow assessments (e.g., single sip, consecutive sip, progressive volume challenges) to instrumental assessment (e.g., videofluoroscopy, nasoendoscopy) for identifying aspiration in adults, 18 years and older, with dysphagia.
National Institutes of Health; Agency for Healthcare Research and Quality; American Speech-Language Hearing Association
Water swallow tests using single sips of small or large controlled volumes of liquid (i.e., 1-5 mL or 6-20 mL) were most effective in identifying individuals who were aspirating. Pooled sensitivity and specificity were 71% (95% CI: 63%-78%) and 90% (95% CI, 86%-93%), respectively for single sip small volumes (1-5 mL). Pooled sensitivity and specificity were 63% (95% CI: 53%-72%) and 90% (95% CI: 84%-94%) for single sip large volumes (6-20 mL). <br /><br />The findings for water swallow tests with consecutive sips of large volumes (e.g., 3 oz water swallow test or greater) had mixed results. The water swallow test with use of an airway response only was more effective in ruling out aspiration (sensitivity = 54%, 95% CI: 45%-62% and specificity = 78%, 95% CI: 71%-83%). While the water swallow test with use of an airway response or voice change was more effective in ruling in aspiration (sensitivity = 91%, 95% CI: 89%-93% and specificity = 53%, 95% CI: 51%-55%). These findings suggest that combining behavioral observations of airway response with voice response improved the diagnostic accuracy of the water swallow test to identify individuals at risk for aspiration.
