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Predictive value of clinical indices in detecting aspiration in patients with neurological disorders
  1. Fabiola Maria,
  2. Monica Mateia,
  3. Maria Gabriella Ceravoloa,
  4. Anna Pisanib,
  5. Alfeo Montesib,
  6. Leandro Provincialia
  1. aNervous System Disease Institute, University of Ancona, Italy, bDepartment of Radiology UmbertoI Hospital of Ancona, Italy
  1. Professor Leandro Provinciali, Clinica di Neuroriabilitazione, Ospedale Torrette, Ancona, Italy I-60020.

Abstract

OBJECTIVES (1) To evaluate the predictive value of a detailed clinical screening of aspiration in patients withneurological diseases, both with and without symptoms of dysphagia taking videofluoroscopy as the gold standard; (2) to assess the existence of risk factors for silent aspiration, measuring the cost-benefit ratio of radiological examination.

METHODS 93 consecutive patients meeting the diagnostic criteria for a neurological disease with a risk of swallowing dysfunctions (cerebrovascular accidents, brain injury, Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, myotonic dystrophy, and abiotrophic diseases) underwent a detailed clinical assessment using a 25 item form to check for symptoms of dysphagia and impairment of the oropharyngeal swallowing mechanism. The 3 oz water swallow test was also performed to assess the aspiration risk. Sensitivity, specificity, positive predictive, and negative predictive values (NPV) of dysphagia, history of cough on swallowing, and 3 oz test positivity, versus videofluoroscopy documented aspiration, taken as the gold standard, were measured in all the patients and in subgroups with different neurological disorders.

RESULTS Non-specific complaints of dysphagia showed a very poor predictive value, whereas the symptom “cough on swallowing” proved to be the most reliable in predicting the risk of aspiration, with 74% sensitivity and specificity, 71% positive predictive, and 77% negative predictive value. The standardised 3-oz test had a higher predictive potential than the clinical signs, but had low sensitivity. The association of cough on swallowing with the 3 oz test gave a positive predictive of 84%, and an negative predictive value of 78%. In cases where the clinical tests failed to detect any impairment, videofluoroscopy documented only a low risk (20%) for mild aspiration.

CONCLUSIONS The association of two clinical items (such as history of cough on swallowing and 3 oz test positivity) provides a useful screening tool, the cost:benefit ratio of which seems very competitive in comparison with videofluoroscopy in aspiration risk evaluation.

  • dysphagia
  • aspiration risk
  • bedside clinical assessment

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