title: Novel Bedside Phonetic Evaluation to Identify Dysphagia and Aspiration Risk.
abstract: BACKGROUND
  There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit.
  
  
  METHODS
  We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded three-component phonetic bedside evaluation. The recordings were scored by two blinded speech-language pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short- and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments.
  
  
  RESULTS
  Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P = .050) and consensus auditory-perceptual evaluation of voice (P = .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P = .001) and aspiration (AUC, 0.67; P = .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P = .001). The short- and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different.
  
  
  CONCLUSIONS
  Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.
authors.affiliation: Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL. Electronic address: Festic.Emir@mayo.edu.
authors.forename: Emir
authors.initials: E
authors.lastname: Festic
authors.affiliation: Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL.
authors.forename: Jose Soto
authors.initials: JS
authors.lastname: Soto
authors.affiliation: Department of Speech-Language Pathology, Mayo Clinic, Jacksonville, FL.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Pitre
authors.affiliation: Department of Speech-Language Pathology, Mayo Clinic, Jacksonville, FL.
authors.forename: Marilu
authors.initials: M
authors.lastname: Leveton
authors.affiliation: Department of Critical Care, Mayo Clinic, Jacksonville, FL.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Ramsey
authors.affiliation: Departments of Neurology and Critical Care, Mayo Clinic, Jacksonville, FL.
authors.forename: William D
authors.initials: WD
authors.lastname: Freeman
authors.affiliation: Department of Health Sciences Research, Biostatistics, Mayo Clinic, Jacksonville, FL.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL.
authors.forename: Augustine S
authors.initials: AS
authors.lastname: Lee
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010699:Phonation / Q000502:physiology*; D010700:Phonetics; D019095:Point-of-Care Systems; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D013066:Speech-Language Pathology
keywords: aspiration; dysphagia; phonation