Skip to main content

Best Practice in Swallowing Assessment in COVID-19

Abstract

The COVID-19 pandemic has significantly altered the world as we know it. Service delivery for the instrumental evaluation of dysphagia in hospitalized patients has been significantly impacted. In many institutions, instrumental assessment was halted or eliminated from the clinical workflow, leaving clinicians without evidence-based gold standards to definitively evaluate swallowing function. The aim of this study was to describe the outcomes of an early, but measured return to the use of instrumental dysphagia assessment in hospitalized patients during the COVID-19 pandemic. Data was extracted via a retrospective medical record review on all patients on whom a swallowing consult was placed. Information on patient demographics, type of swallowing evaluation, and patient COVID status was recorded and analyzed. Statistics on staff COVID status were also obtained. Over the study period, a total of 4482 FEES evaluations and 758 MBS evaluations were completed. During this time, no staff members tested COVID-positive due to workplace exposure. Results strongly support the fact that a measured return to instrumental assessment of swallowing is an appropriate and reasonable clinical shift during the COVID-19 pandemic.

This is a preview of subscription content, access via your institution.

Graph 1
Graph 2

References

  1. Lammers MJW, Lea J, Westerberg BD. Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic. J Otolaryngol-Head Neck Surg. 2020;49(1):36–8.

    Article  Google Scholar 

  2. Miles A, Connor NP, Desai RV, Jadcherla S, Allen J, Brodsky M, Garand KL, Malandraki GA, McCulloch TM, Moss M, Murray J, Pulia M, Riquelme LF, Langmore SE. Dysphagia care across the continuum: a multidisciplinary Dysphagia Research Society taskforce report of service-delivery during the COVID-19 Global Pandemic. Dysphagia. 2020;36(2):170–82. https://doi.org/10.1007/s00455-020-10153-8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bolton L, Brady G, Coffey M, Haines J, Roe J, Wallace S. Speech and language therapist-led endoscopic procedures in the COVID-19 pandemic. R Coll Speech Lang Ther. 2020;1(8):1–17.

    Google Scholar 

  4. Brodsky MB, Gilbert RJ. The long-term effects of COVID-19 on dysphagia evaluation and treatment. Arch Phys Med Rehabil. 2020;101(9):1662–4. https://doi.org/10.1016/j.apmr.2020.05.006.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Muraleedharan M, Kaur S, Arora K, Singh Virk RS. Otolaryngology practice in Covid 19 Era: a road-map to safe endoscopies. Indian J Otolaryngol Head Neck Surg. 2020;73(1):101–3.

    Article  Google Scholar 

  6. Bolton L, Mills C, Wallace S, Brady MC. Aerosol generating procedures, dysphagia assessment and COVID-19: a rapid review. Int J Lang Commun Disord. 2020;55(4):629–36. https://doi.org/10.1111/1460-6984.12544.

    Article  PubMed  Google Scholar 

  7. Guda NM, Emura F, Reddy DN, Rey J, Seo D, Gyokeres T, Tajiri H, Faigel D. Recommendations for the operation of endoscopy centers in the setting of the COVID-19 pandemic—World Endoscopy Organization guidance document. Dig Endosc. 2020;32(6):844–50.

    Article  Google Scholar 

  8. Namasivayam-MacDonald AM, Riquelme LF. Speech-language pathology management for adults with COVID-19 in the acute hospital setting: initial recommendations to guide clinical practice. Am J Speech Lang Pathol. 2020;29(4):1850–916. https://doi.org/10.1044/2020_AJSLP-20-00096.

    Article  PubMed  Google Scholar 

  9. Mattei A, Amy de la Bretèque B, Crestani S, Crevier-Buchman L, Galant C, Hans S, Julien-Laferrière A, Lagier A, Lobryeau C, Marmouset F, Robert D, Woisard V, Giovanni A. Guidelines of clinical practice for the management of swallowing disorders and recent dysphonia in the context of the COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(3):173–5. https://doi.org/10.1016/j.anorl.2020.04.011.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Frajkova Z, Tedla M, Tedlova E, Suchankova M, Geneid A. Postintubation dysphagia during COVID-19 outbreak-contemporary review. Dysphagia. 2020;35(4):549–57. https://doi.org/10.1007/s00455-020-10139-6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fritz MA, Howell RJ, Brodsky MB, Suiter DM, Dhar SI, Rameau A, Richard T, Skelley M, Ashford JR, O’Rourke AK, Kuhn MA. Moving forward with dysphagia care: implementing strategies during the COVID-19 pandemic and beyond. Dysphagia. 2020;36(2):161–9. https://doi.org/10.1007/s00455-020-10144-9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. McCullough GH, Wertz RT, Rosenbek JC, Dinneen C. Clinicians’ preferences and practices in conducting clinical/bedside and videofluoroscopic swallowing examinations in an adult, neurogenic population. Am J Speech Lang Pathol. 1999;8:149–63.

    Article  Google Scholar 

  13. Leder SB, Suiter DM. The Yale Swallow Protocol: an evidence-based approach to decision making. New York: Springer; 2014. https://doi.org/10.1007/978-3-319-05113-0.

    Book  Google Scholar 

  14. McCullough GH, Rosenbek JC, Wertz RT, McCoy S, Mann G, McCullough K. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res. 2005;48:1288–93.

    Article  Google Scholar 

  15. Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an accurate bedside swallowing evaluation decision tree algorithm for detecting aspiration in acute respiratory failure survivors. Chest. 2020;158(5):1923–33.

    Article  Google Scholar 

  16. Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical assessment of swallowing and prediction of dysphagia severity. Am J Speech Lang Pathol. 1997;6(4):17.

    Article  Google Scholar 

  17. Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia. 1999;14(1):44–51.

    CAS  Article  Google Scholar 

  18. Splaingard M, Hutchins B, Sulton L, Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil. 1988;69(8):637.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the assistance of Jennifer Coutinho for her contribution of the clinical algorithms and to the clinical staff of Yale New Haven Hospital for providing the care that made this research possible. The authors would like to thank Caitlin Partridge at JDAT-Research, YCCI at Yale University School of Medicine for electronic medical record data acquisition and unwavering support of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Heather Warner.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1

Appendix 1

Algorithm A: Initial Clinical Workflow of Study Period.

figure a

Algorithm B: Final Clinical Workflow of Study Period. *PUI (person under investigation): patient with undetermined COVID status, same as rule out patient.

figure b

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Warner, H., Young, N. Best Practice in Swallowing Assessment in COVID-19. Dysphagia (2022). https://doi.org/10.1007/s00455-022-10478-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00455-022-10478-6

Keywords

  • Dysphagia
  • Deglutition
  • Swallowing assessment
  • FEES
  • COVID