Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis.
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.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, MD. Electronic address: brodsky@jhmi.edu.
Martin B
MB
Brodsky
College of Health Sciences, Division of Communication Sciences and Disorders, University of Kentucky, Lexington, KY.
Debra M
DM
Suiter
Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
Marlís
M
González-Fernández
Department of Medicine, Division of General Internal Medicine, Hospitalist Program, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD.
Henry J
HJ
Michtalik
National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD.
Tobi B
TB
Frymark
National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD.
Rebecca
R
Venediktov
National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD.
Tracy
T
Schooling
D000328:Adult; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis*; D004724:Endoscopy / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards; D010779:Photofluorography / Q000379:methods; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D000067716:Point-of-Care Testing; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity
aspiration; dysphagia; pneumonia; review; screening