Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients

York, Justine Dallal; Anderson, A.; DiBiase, Lauren; Jeng, Eric I.; Plowman, Emily K.

doi:10.1007/s00455-021-10333-0

Cited by 7 publications

(6 citation statements)

References 61 publications

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“…In addition, older patients have a higher probability of degeneration of advanced cranial nerve function and abnormal swallowing reflex function, which further increases the susceptibility of swallowing dysfunction [ 27 , 47 – 49 ]. Due to the weakening of the transport capacity of the tongue muscle and the collapse of the tongue muscle in elderly patients, the food bolus will leak in advance and later, and the oral transport time will be prolonged during the feeding process [ 50 , 51 ]. Clinical medical workers should fully evaluate the swallowing function of elderly stroke patients with dysphagia, and carry out targeted rehabilitation training to prevent the occurrence of aspiration.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

Yang

Pan

2022

PLoS ONE

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Background Dysphagia is a common yet serious complication in stroke patients. We aimed to conduct a meta-analysis and systematic review to evaluate the risk factors of dysphagia in patients with ischemic stroke, to provide insights to the clinical treatment and nursing care of dysphagia. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Database, China Biomedical Literature Database (CBM) for studies on dysphagia in patients with ischemic stroke up to January 31, 2022. The quality of the literature was evaluated using the Newcastle-Ottawa scale. Meta-analysis was performed using RevMan 5.3 software. Results A total of 10 studies involving 4637 ischemic stroke patients were included, 1183(25.51%) patients had dysphagia after stroke. The synthesized outcomes showed that elder age (SMD = 0.42, 95%CI:0.34–0.50), hypertension (OR = 1.96, 95%CI:1.48–2.61), diabetes (OR = 1.83, 95%CI:1.47–2.28), brainstem stroke (OR = 2.12, 95%CI:1.45–3.09) were associated with dysphagia in patients with ischemic stroke (all P<0.05). There was no significant difference in the gender between dysphagia and no dysphagia patients (OR = 1.07, 95%CI:0.91–1.27, P = 0.40). Egger regression tests indicated there were no significant publication biases in the synthesized outcomes (all P>0.05). Conclusions Elder age, hypertension, diabetes and brainstem stroke are associated with the development of dysphagia in patients with ischemic stroke. Attention should be paid to the assessment and early intervention of those risk factors for dysphagia to improve the prognosis of stroke patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

Yang

Pan

2022

PLoS ONE

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“…In this study, Dallal York and colleagues reported both a sensitivity and specificity of 63% for the 3 oz. WST to detect aspiration, a NPV of 82%, and a PPV of 39% 24 …”

Section: Discussionmentioning

confidence: 99%

“…This latter finding along with recent 3 oz. WST data in cardiac surgical patients 24 highlight the need to develop and validate population‐specific screening tools.…”

Section: Introductionmentioning

confidence: 99%

Discriminant ability of the 3‐ounce water swallow test to detect aspiration in amyotrophic lateral sclerosis

Donohue

Gray

Chapin

et al. 2021

Neurogastroenterology Motil

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Background Given the need for quick and accurate dysphagia screening tools to optimize referral workflows and resource utilization in fast‐paced multidisciplinary amyotrophic lateral sclerosis (ALS) clinics, we evaluated the discriminant ability of the 3 oz. water swallow test (WST) to detect aspiration in individuals with ALS. Methods A total of 212 paired 3 oz. WST (index test) and standardized videofluoroscopic swallow studies (reference test) were completed in individuals with a confirmed diagnosis of ALS. Blinded raters analyzed swallowing safety using the validated penetration‐aspiration scale (PAS; non‐aspirator: PAS < 6; aspirator: PAS ≥ 6). Receiver operating characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. Key Results Index test: 78 (36.8%) WSTs were scored as a fail and 134 (63.2%) as a pass. Reference test: Aspiration was confirmed in 67 (31.6%) reference tests with 145 (68.4%) reference tests verified as having no aspiration. Sensitivity and specificity of the 3 oz. WST to detect radiographically confirmed aspiration was 55.2% and 71.7%, respectively (AUC: 0.635, PPV: 47.4%, NPV: 77.6%). Conclusions & Inferences In this dataset, the 3 oz. WST did not demonstrate adequate sensitivity or specificity to detect aspiration in people with ALS as a stand‐alone dysphagia screening tool.

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“…The currently used bedside swallow evaluation has important limitations that make it less than ideal. Overall, studies suggest variable sensitivity and specificity 4–6 . Even in experienced hands, the bedside swallow examination may miss silent aspiration in up to 40% of patients 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Overall, studies suggest variable sensitivity and specificity. [4][5][6] Even in experienced hands, the bedside swallow examination may miss silent aspiration in up to 40% of patients. 7 In these false negative cases, a patient may be given food that they are not able to tolerate safely.…”

Section: Introductionmentioning

confidence: 99%

Acoustic Screening of the “Wet voice”: Proof of Concept in an ex vivo Canine Laryngeal Model

et al. 2022

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BackgroundCurrent protocols for bedside swallow evaluation have high rates of false negative results. Though experts are not consistently able to screen for aspiration risk by assessing vocal quality, there is emerging evidence that vocal acoustic parameters are significantly different in patients at risk of aspiration. Herein, we aimed to determine whether the presence of material on the vocal folds in an excised canine laryngeal model may have an impact on acoustic and aerodynamic measures.MethodsTwo ex vivo canine larynges were tested. Three liquids of different viscosities (1:100 diluted glycerin, pure glycerin, and honey‐thick Varibar) were placed on the vocal folds at a constant volume. Acoustic and aerodynamic measures were obtained in both adducted and abducted vocal fold configurations. Intraglottal high‐speed imaging was used to approximate the maximum divergence angle of the larynges in the studied conditions and examine its relationship to vocal efficiency (VE) and acoustic measures.ResultsIn glottic insufficiency conditions only, we found that several acoustic parameters could predict the presence of material on the vocal folds. Based on the combination of the aerodynamic and acoustic data, we found that decreased spectral energy in the higher harmonics was associated with decreased VE in the presence of material on the vocal folds and/or glottic insufficiency.ConclusionDecreased spectral energy in the higher harmonics of the voice was found to be a potential biomarker of swallowing dysfunction, as it correlates with decreased vocal efficiency due to material on the vocal folds and/or glottic insufficiency, both of which are known risk factors for aspiration.Level of EvidenceNA Laryngoscope, 133:2517–2524, 2023

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Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients

Cited by 7 publications

References 61 publications

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

Discriminant ability of the 3‐ounce water swallow test to detect aspiration in amyotrophic lateral sclerosis

Acoustic Screening of the “Wet voice”: Proof of Concept in an ex vivo Canine Laryngeal Model

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