Diagnostic Accuracy of Screening Tools for Silent Aspiration in Patients With Dysphagia: A Systematic Review and Meta-Analysis

Frontiers in Neurology

Sun, W. J., Cui, W. Y., et al. (2025).

Frontiers in Neurology, 16, 1576869.

<div>This systematic review with meta-analysis investigates the diagnostic accuracy of silent aspiration screening tools for adults with dysphagia, 18 years and older.</div>

Department of Science and Technology of Sichuan Province (China)

From database inception to July 1, 2024

<div>Diagnostic studies comparing at least two silent aspiration screening tools. Excludes reviews, posters, meeting abstracts, protocols, and letters.</div>

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<div>Screening tools showed the ability to identify silent aspiration in adults with dysphagia as compared to the gold standard videofluoroscopic Swallowing Study (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES) tools. Findings for the individual screening tools included the following:&nbsp;</div> <div> <ul> <li><strong>Cough Reflex Test (CRT): </strong>The CRT demonstrated moderate value in diagnosing and predicting silent aspiration, with a combined sensitivity of 0.65 and a combined specificity of 0.71. Citric acid-induced CRT showed greater safety (sensitivity = 0.75; specificity = 0.71) than water-induced CRT (sensitivity = 0.46; specificity = 0.62).&nbsp;</li> <li><strong>Swallowing And Breath Sound Analysis:</strong> One study reported that Swallowing And Breath Sound Analysis demonstrated an accuracy, sensitivity, and specificity of 0.86 for diagnosing silent aspiration. The Swallowing And Breath Sound Analysis was non-invasive and efficient compared to instrumental examination.&nbsp;</li> <li><strong>Clinical Swallow Examination (CSE):</strong> One study found that CSE alone had a sensitivity of 0.71 and a specificity of 0.88. When combined with the CRT, the sensitivity was 0.86 and the specificity was 0.69.&nbsp;</li> <li><strong>Modified Bedside Swallowing Assessment (MBSA): </strong>MBSA yielded extremely low sensitivity (0) and high specificity (0.98).</li> <li><strong>CRT combined with Modified Water Swallowing Test (MWST): </strong>This combination demonstrated a sensitivity of 0.71 and a specificity of 0.88.</li> </ul> </div> <div>Limitations of this review included the reliance on narrative analysis, the inability to conduct subgroup analysis, the paucity of available studies, and the inability to conduct a network meta-analysis. Additional research is needed to investigate the application value of different screening tools in clinical practice for adults with dysphagia.</div>