Screening Accuracy for Aspiration Using Bedside Water Swallow Tests

A Systematic Review and Meta-Analysis

Martin B Brodsky, Debra M. Suiter, Marlis Gonzalez Fernandez, Henry Joseph Michtalik, Tobi B. Frymark, Rebecca Venediktov, Tracy Schooling

Research output: Contribution to journalArticle

Abstract

Background Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration. Methods Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines. Results Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration. Conclusions Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.

Original languageEnglish (US)
Pages (from-to)148-163
Number of pages16
JournalChest
Volume150
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Swallows
Deglutition
Meta-Analysis
Water
Voice Quality
Aspiration Pneumonia
Airway Obstruction
Deglutition Disorders
Observational Studies
Comorbidity
Epidemiology
Hospitalization
Databases
Prospective Studies
Guidelines
Costs and Cost Analysis
Mortality
Research

Keywords

  • aspiration
  • dysphagia
  • pneumonia
  • review
  • screening

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Screening Accuracy for Aspiration Using Bedside Water Swallow Tests : A Systematic Review and Meta-Analysis. / Brodsky, Martin B; Suiter, Debra M.; Gonzalez Fernandez, Marlis; Michtalik, Henry Joseph; Frymark, Tobi B.; Venediktov, Rebecca; Schooling, Tracy.

In: Chest, Vol. 150, No. 1, 01.07.2016, p. 148-163.

Research output: Contribution to journalArticle

Brodsky, Martin B ; Suiter, Debra M. ; Gonzalez Fernandez, Marlis ; Michtalik, Henry Joseph ; Frymark, Tobi B. ; Venediktov, Rebecca ; Schooling, Tracy. / Screening Accuracy for Aspiration Using Bedside Water Swallow Tests : A Systematic Review and Meta-Analysis. In: Chest. 2016 ; Vol. 150, No. 1. pp. 148-163.
@article{b8d5001180d24654bb3d1c18351b775e,
title = "Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis",
abstract = "Background Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration. Methods Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines. Results Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71{\%} sensitive (95{\%} CI, 63{\%}-78{\%}) and 90{\%} specific (95{\%} CI, 86{\%}-93{\%}). Consecutive sips of 90 to 100 mL trials were 91{\%} sensitive (95{\%} CI, 89{\%}-93{\%}) and 53{\%} specific (95{\%} CI, 51{\%}-55{\%}). Trials of progressively increasing volumes of water were 86{\%} sensitive (95{\%} CI, 76{\%}-93{\%}) and 65{\%} specific (95{\%} CI, 57{\%}-73{\%}). Airway response with voice change improved overall accuracy in identifying aspiration. Conclusions Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.",
keywords = "aspiration, dysphagia, pneumonia, review, screening",
author = "Brodsky, {Martin B} and Suiter, {Debra M.} and {Gonzalez Fernandez}, Marlis and Michtalik, {Henry Joseph} and Frymark, {Tobi B.} and Rebecca Venediktov and Tracy Schooling",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.chest.2016.03.059",
language = "English (US)",
volume = "150",
pages = "148--163",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",

}

TY - JOUR

T1 - Screening Accuracy for Aspiration Using Bedside Water Swallow Tests

T2 - A Systematic Review and Meta-Analysis

AU - Brodsky, Martin B

AU - Suiter, Debra M.

AU - Gonzalez Fernandez, Marlis

AU - Michtalik, Henry Joseph

AU - Frymark, Tobi B.

AU - Venediktov, Rebecca

AU - Schooling, Tracy

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration. Methods Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines. Results Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration. Conclusions Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.

AB - Background Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration. Methods Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines. Results Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration. Conclusions Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.

KW - aspiration

KW - dysphagia

KW - pneumonia

KW - review

KW - screening

UR - http://www.scopus.com/inward/record.url?scp=84990048300&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990048300&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2016.03.059

DO - 10.1016/j.chest.2016.03.059

M3 - Article

VL - 150

SP - 148

EP - 163

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -