title: Nasolaryngoscopic validation of a set of clinical predictors of aspiration in a critical care setting.
abstract: BACKGROUND
  Aspiration is frequent in patients with acute neurologic disorders and swallowing dysfunction. Its incidence in stroke, as high as 51%, increases mortality by up to 3 times. Pneumonia, its main complication, further increases morbidity, mortality, and patient care costs. The objective of this study was to evaluate a set of bedside predictors of aspiration ["wet voice," 3-oz water swallow test, and cervical auscultation in an intensive care unit (ICU)] and compare them with nasolaryngoscopy as the gold standard.
  
  
  METHODS
  We conducted a prospective, nonblinded study of bedside predictors of aspiration risks in 65 consecutive ICU patients with an acute neurologic disorder or a severe medical or surgical condition with decreased level of consciousness.
  
  
  RESULTS
  Endoscopic aspiration was detected in 17 patients. Sensitivities for wet voice, 3-oz water swallow test, and cervical auscultation were 58.82%, 88.23%, and 82.35%; specificities were 78.26%, 62.50%, and 80.43%. Positive predictive values were 50%, 45.45%, and 60.86%, and negative predictive values were 83.72%, 93.75%, and 92.50%, respectively. Positive likelihood ratios were 2.70, 2.35, and 4.20, respectively. The association of 2 positive clinical predictors, wet voice and cervical auscultation or wet voice and 3-oz water swallow test, improved specificity to 92.85% and 84.61%, positive predictive values to 83.33% and 69.23%, and likelihood ratios to 10.76 and 5.85, respectively.
  
  
  CONCLUSIONS
  Bedside clinical predictors for aspiration risks are a useful screening tool for ICU patients presenting with risk factors for this complication.
authors.affiliation: *Servicios Broncopulmonar y Cuidados Intensivos ‡Servicio de Neurología, Clínica Alemana de Santiago †Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Chile.
authors.forename: Iván R
authors.initials: IR
authors.lastname: Caviedes
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Hoppe
authors.forename: María A
authors.initials: MA
authors.lastname: López