Dysphagia

, Volume 19, Issue 4, pp 211–218 | Cite as

Bronchial Auscultation: An Effective Adjunct to Speech and Language Therapy Bedside Assessment When Detecting Dysphagia and Aspiration?

  • Jane L. Shaw
  • Sam Sharpe
  • Sarah E. Dyson
  • Sue Pownall
  • Stephen Walters
  • Carol Saul
  • Pam Enderby
  • Kerry Healy
  • Helen O’Sullivan
Article

Abstract

Detection of aspiration by bedside examination has frequently been found to be clinically inadequate when compared with videofluoroscopy (VF) as the gold standard. In Doncaster, UK, a new multidisciplinary approach to bedside assessment was devised using physiotherapists (PT) performing bronchial auscultation (BA) in combination with the speech and language therapists’ (SLT) clinical examination of dysphagia. In this study 105 patients referred for VF examination of dysphagia were first tested by the BA team. Comparison was made between the results of the VF team and the results of the BA team in classifying the patients as “aspirating” or at “risk of aspirating.” A high degree of agreement was found for risk of aspiration (sensitivity 87%), although specificity was low (37%). BA was highly specific (88%) when confirming the absence of aspiration, but sensitivity to the presence of aspiration was 45%. From the 105 patients tested, the BA team would have failed to modify the diet in only one subject who was aspirating and would have unnecessarily modified the diet of 17 subjects. In conclusion, in the sample population of individuals with complex dysphagia, the BA team approach reliably detected patients identified by VF as at risk of aspiration. In the group of patients identified by VF as aspirating, the BA team proved unreliable in detecting the presence of aspiration, although it did reliably identify patients who were not aspirating. BA is a potentially useful clinical tool which requires further research.

Keywords

Aspiration Bronchial auscultation Videofluoroscopy Dysphagia Deglutition Deglutition disorders 
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Notes

Acknowledgments

We thank Professor Ann Parry (Project Director for Health and Social Care Research), Mark Parker (Research Lead, Sheffield SLT Agency), Sandra Robertson (Course Leader, Speech and Language Therapy, Manchester Metropolitan University), Dr M. C. Collins (Consultant Radiologist, Sheffield RHH), Anita McCourt (SLT, Sheffield RHH), Julie Port (Senior Physiotherapist, Doncaster Royal Infirmary), Lesley Middlemas (Senior Physiotherapist, Montagu Hospital) Laura DiCiacca (Superintendent Physiotherapist, Doncaster Royal Infirmary), and Elaine Walstow (Admin, Doncaster Royal Infirmary). The data collection team comprised Kerry Healy, Anita McCourt, Lesley Middlemas, Helen O’Sullivan, Julie Port, and Sue Pownall.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jane L. Shaw
    • 1
  • Sam Sharpe
    • 1
  • Sarah E. Dyson
    • 1
  • Sue Pownall
    • 2
  • Stephen Walters
    • 3
  • Carol Saul
    • 3
  • Pam Enderby
    • 3
  • Kerry Healy
    • 1
  • Helen O’Sullivan
    • 1
  1. 1.Speech and Language Therapy Department, Doncaster and Bassetlaw NHS TrustDoncaster Royal InfirmaryDoncasterUnited Kingdom
  2. 2.Speech and Language Therapy DepartmentSheffield Teaching Hospitals, Royal Hallamshire Hospital (RHH)SheffieldUnited Kingdom
  3. 3.School of Health and Related ResearchRegent Court, SheffieldUnited Kingdom

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