Background: Oropharyngeal aspiration, the recurrent entry of food and/or fluids below the level of the vocal cords, can result in a range of complications in infants, children and adults including: chronic lung diseases, aspiration pneumonia, malnutrition and/or dehydration. Video Fluoroscopic Swallow Study is the Gold Standard assessment of oropharyngeal aspiration but is resource intense, exposes the patient to radiation and is not available in all hospitals and centers. The Clinical Swallow Assessment is a bedside swallow assessment used to screen and/or assess for oropharyngeal aspiration without evidence of the diagnostic test accuracy of this test.
Objectives: To synthesize the best available evidence on the diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment compared with Video Fluoroscopic Swallow Study in diagnosing oropharyngeal aspiration in children and adults with dysphagia.
Inclusion criteria: Types of participants
Any patients referred for swallowing assessment, specifically assessed for oropharyngeal aspiration - no exclusion based on age or gender. Study results excluded for the population of head and neck cancer patients, patients with a tracheostomy in situ and patients with craniofacial anomalies.
Focus of the review
Examine the diagnostic test accuracy of clinical swallow assessment, as compared with Video Fluoroscopic Swallow Study
Types of studies
This review considered any relevant cross sectional study that considered diagnostic accuracy.
Types of outcomes
Outcomes of interest were the sensitivity and specificity of the clinical swallow, as compared with the video fluoroscopic study and the positive and negative predictive values. Where this data was not reported in the studies, these measures were calculated from the reported raw data.
Search strategy: Thirteen major databases were searched from their inception until 31 April 2012. There were no limits during the search stage as relevant studies were omitted if search filters such as "English" and "Human" were applied.
Methodological quality: Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist.
Data collection: Data was collected using the Standards for the Reporting of Diagnostic Accuracy Studies (STARD) checklist
Data synthesis: Sensitivity and specificity measures were combined in meta-analysis to generate a summary receiver operator curve.
Results: A total of 1787 titles were initially identified and following duplicate removal and screening against inclusion criteria, 13 studies were included in the review. Methodological quality was high. The review found that test sensitivity varied from 21% to 93%, the specificity from 46% to 93%. The mean sensitivity and specificity was 71% and 76% respectively.
Conclusions: There is good evidence that clinical swallow assessment is a reasonably accurate test for aspiration in dysphagic patients, with an overall summary sensitivity of 71% and specificity of 76%, when compared with the video fluoroscopic swallow study test. However, these results are based predominantly on adult, acute post stroke patients.
Implications for practice
Results are based predominantly on adult, acute post stroke patients and may not be generalized to other patient groups. This systematic review provides data for centers where VFSS is not available regarding the diagnostic test accuracy of clinical swallow assessment for oropharyngeal aspiration.
Implications for research
Further research is needed for infants and children with dysphagia as well as neurologically intact and normally developing infants and children.