Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Reha
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ORIGINAL ARTICLE
Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Rehabilitation Hospital Leandro Castro Velasco1 · Rui Imamura2 · Ana Paula Valeriano Rêgo3 · Priscilla Rabelo Alves4 · Lorena Pacheco da Silva Peixoto5 · José de Oliveira Siqueira6 Received: 26 February 2020 / Accepted: 3 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center. Keywords Deglutition disorders · Oropharyngeal dysphagia · aspiration pneumonia · Screening test · Deglutition · Hospitalization
* Leandro Castro Velasco [email protected] 1
Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua T‑14, número 1529, apartamento 2301, bloco Monet, Goiânia, GO CEP 74230‑130, Brasil
2
Department of Otorhinolaryngology, School of Medicine, University of São Paulo, Avenida Padre Pereira de Andrade, 545, apto 153‑F, Boacava, São Paulo 05469‑000, Brazil
3
Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Avenida T‑4, número 550, Condomínio Ilhas Do Caribe, apartamento 1303, Bloco A, Setor Bueno, Goiânia, Goiás 74230030, Brazil
4
Department of Speech‑Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Ru
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