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Dysphagia

, Volume 18, Issue 4, pp 305–306 | Cite as

A Comment on “Aspiration Risk after Stroke: Comparison of Clinical Examination and Fiberoptic Endoscopic Evaluation of Swallowing” (Dysphagia 17:214–218, 2002)

  • Springer-Verlag
Letter to the Editor
  • 144 Downloads

Working as a speech therapist in a neurology department, I have read the article by Leder and Espinosa [1] with great interest. I agree with Dr. Leder and his colleague that “visualization allows for accurate diagnostic information” and that instrumental evaluations should be used when easily available. The focus of their study, however, is not entirely clear because the concepts of “screening” and “examination” seem to have been confused. First, the purpose of a validation study is to determine the diagnostic value of an index test or screening against a reference test or “gold standard” [2]. Therefore, the authors’ conclusion that FEES is a more adequate diagnostic instrument than clinical bedside testing is redundant. Second, it is not made clear why the authors did not compare the diagnostic values with those of the original study by Daniels et al. [3]. In terms of likelihood ratio [2], the screening is practically worthless with a positive likelihood ratio of 1.2 and a negative...

References

  1. 1.
    Leder, SB, Espinosa, JF 2002Aspiration risk after stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing.Dysphagia17214218PubMedGoogle Scholar
  2. 2.
    Sackett, DL, Straus, SE, Richardson, WS, Rosenberg, W, Haynes, RB 2000Evidence-based medicine.Churchill LivingstoneTorontoGoogle Scholar
  3. 3.
    Daniels, SK, McAdam, CP, Brailey, K, Foundas, AL 1997Clinical assessment of swallowing and prediction of dysphagia severity.Am J Speech Lang Pathol61724CrossRefGoogle Scholar
  4. 4.
    Logemann, JA 1998Evaluation and treatment of swallowing disorders.Pro-EdAustin, TXGoogle Scholar
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    Scottish Intercollegiate Guidelines Network.1999Management of Patients with Stroke. III: Identification and Management of Dysphagia.SIGNEdinburgh[available on the Internet: http://www.sign.ac.uk/guidelines]Google Scholar
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    Kalf, JG 2002Swallow screening after stroke. An evidence-based review [in Dutch].Logopedie en Foniatrie747683Google Scholar
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    Lim, SHB, Lieu, PK, Phua, SY, Seshadri, R, Venketasubramanian, N, Lee, SH, Choo, PWJ 2001Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke.Dysphagia1616PubMedGoogle Scholar
  8. 8.
    Daniels, SK, McAdam, CP, Brailey, K, Foundas, AL 1997Clinical assessment of swallowing and prediction of dysphagia severity.Am J Speech Lang Pathol61724Google Scholar

Copyright information

© Springer-Verlag New York Inc. 2003

Authors and Affiliations

  • Springer-Verlag
    • 1
  1. 1.New YorkUSA

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