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Three Tests for Predicting Aspiration without Videofluorography

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Abstract

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium). Sixty-three individuals with dysphagia were each evaluated with the three non-VFG tests and a VFSS; 29 patients aspirated on the VFSS. The summed scores of all three non-VFG tests had a sensitivity of 90% for predicting aspiration and specificity of 71% for predicting its absence. The summed scores of the water and food tests (without X-ray) had a sensitivity of 90% and specificity of 56%. These non-VFG tests have limitations but may be useful for assessing patients when VFSS is not feasible. They may also be useful as screening procedures to determine which dysphagia patients need a VFSS.

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Acknowledgements

The authors thank Karen Hiiemae and the GULP group for helpful comments on the manuscript.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University and Good Samaritan Hospital, Baltimore, Maryland, USA

    Haruka Tohara DDS, Keith A. Mays DDS, MS, Keith Kuhlemeier PhD & Jeffrey B. Palmer MD

  2. Department of Rehabilitation Medicine, Fujita Health University, Aichi, Japan

    Haruka Tohara DDS & Eiichi Saitoh MD

  3. Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan

    Haruka Tohara DDS

  4. Department of Restorative Dentistry, Baltimore College of Dental Surgery, Baltimore, Maryland, USA, USA

    Keith A. Mays DDS, MS

  5. Division of Hospital Dentistry, University of Maryland Medical Center, Baltimore, Maryland, USA, USA

    Keith A. Mays DDS, MS

  6. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA, USA

    Jeffrey B. Palmer MD

Authors
  1. Haruka Tohara DDS
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  2. Eiichi Saitoh MD
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  3. Keith A. Mays DDS, MS
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  4. Keith Kuhlemeier PhD
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  5. Jeffrey B. Palmer MD
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Corresponding author

Correspondence to Haruka Tohara DDS.

Appendix: Definitions

Appendix: Definitions

  1. 1

    True positives: Cases who have a condition and test positive for the condition. In the context of this article, a case is a true positive if the patient is predicted to aspirate based on the water, food, X-ray, or combined tests and actually does aspirate on the VFSS.

  2. 2

    True negatives: Cases who do not have a condition and test negative for the condition. In the context of this article, a case is a true negative if the patient is predicted not to aspirate based on the water, food, X-ray, or combined tests and actually does not aspirate on the VFSS.

  3. 3

    False Positives: Cases who not have a condition but test positive for the condition. In the context of this article, a case is a false positive if the patient is predicted to aspirate based on the water, food, X-ray, or combined tests but does not actually aspirate on the VFSS.

  4. 4

    False negatives: Cases who have a condition but test negative for the condition. In the context of this article, a case is a false negative if the patient is not predicted to aspirate based on the water, food, X-ray, or combined tests but actually does aspirate on the VFSS.

  5. 5

    Sensitivity: Fraction of patients with the condition (in this case, aspiration) who have a positive test result. Sensitivity = true positives/(true positives + false negatives).

  6. 6

    Specificity: Fraction of patients without the condition (in this case, non-aspirators) who have a negative test result. Specificity = true negatives/(true negatives + false positives).

  7. 7

    Positive predictive value: Probability of actually having a condition among patients who test positive for the condition. PPV = true positives/(true positives + false positives).

  8. 8

    Negative predictive value: Probability of actually not having a condition among patients who test negative for the condition. NPV = true negatives/(true negatives + false negatives).

  9. 9

    Concordance rate: Percent agreement between the test results and actual presence of the condition. CR = (true positive + true negatives)/(true positives + true negatives + false positives + false negatives).

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Tohara, H., Saitoh, E., Mays, K.A. et al. Three Tests for Predicting Aspiration without Videofluorography . Dysphagia 18, 126–134 (2003). https://doi.org/10.1007/s00455-002-0095-y

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