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.
Similar content being viewed by others
References
C Gordon RL Hewer DT Wade (1987) ArticleTitleDysphagia in acute stroke Br Med J (Clin Res Ed) 295 411–414 Occurrence Handle1:STN:280:BieD3c7ksFE%3D
J Horner EW Massey JE Riski DL Lathrop KN Chase (1988) ArticleTitleAspiration following a stroke: clinical correlates and outcome Neurology 38 1359–1362 Occurrence Handle1:STN:280:BieA3MbivFc%3D Occurrence Handle3412582
J Horner FG Buoyer MJ Alberts MJ Helms (1991) ArticleTitleDysphagia following a brain stem stroke Arch Neurol 48 1170–1173 Occurrence Handle1:STN:280:By2D287mt1E%3D Occurrence Handle1953404
J Robbins RL Levin A Master JC Rosenbek GB Kempster (1993) ArticleTitleSwallowing after a unilateral stroke of the cerebral cortex Arch Phys Med Rehabil 74 1295–1300 Occurrence Handle10.1016/0003-9993(93)90082-L Occurrence Handle1:STN:280:ByuD1c3nt1w%3D Occurrence Handle8259895
PS Reynolds L Gilbert DC Good VA Knappertz C Crenshaw SL Wayne D Pilbury CH Tegeler (1998) ArticleTitlePneumonia in dysphagic stroke J Neurol Rehabil 12 15–21
Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients. Evidence Report/Technology Assessment No. 8. (Prepared by ECRI Evidence-based Practice Center under Contract No. 290-97-0020.) AHCPR Publication No. 99-E024. Rockville. MD: Agency for Health Care Policy and Research, July 1999
DG Smithard PA O’Neill C Parks J Morris (1996) ArticleTitleComplications and outcomes following acute CVA, Does dysphagia matter? Stroke 27 1200–1204 Occurrence Handle1:STN:280:BymB1M%2FgtFM%3D Occurrence Handle8685928
L Perry CP Lowe (2001) ArticleTitleScreening for dysphagia and aspiration in acute stroke: A systematic review Dysphagia 16 IssueID1 7–18 Occurrence Handle10.1007/s004550000047 Occurrence Handle1:STN:280:DC%2BD3M7ktFyitg%3D%3D Occurrence Handle11213249
R Martino G Pron N Diamant (2000) ArticleTitleScreening for oropharyngeal dysphagia in stroke Dysphagia 15 IssueID1 19–30 Occurrence Handle1:STN:280:DC%2BD3c%2Fmt1KrtQ%3D%3D Occurrence Handle10594255
SE Langmore MS Terpenning A Schork Y Chen JT Murray D Lopatin WJ Loesche (1998) ArticleTitlePredictors of aspiration pneumonia: how important is dysphagia? Dysphagia 13 69–81 Occurrence Handle1:STN:280:DyaK1c7nsVCrtA%3D%3D Occurrence Handle9513300
DG Smithard PA O’Neill C Parks R England DS Renwick R Wyatt J Morris DF Martin (1998) ArticleTitleCan bedside assessment reliably exclude aspiration following acute CVA? Age Ageing 27 99–106
JA Logemann (1983) Evaluation and treatment of swallowing disorders College Hill Press San Diego CA
ML Splaingard B Hutchins LD Sulton G Chaudhuri (1988) ArticleTitleAspiration in rehabilitation patients. Videofluoroscopy vs bedside clinical assessment Arch Phys Med Rehabil 69 637–640 Occurrence Handle1:STN:280:BieA3cfmvFQ%3D Occurrence Handle3408337
PMW Bath FJ Bath DG Smithard (2002) ArticleTitleInterventions for dysphagia in acute stroke Cochrane Database Syst Rev . IssueID2 CD000323
SB Leder CT Sasaki MI Burrall (1998) ArticleTitleFiberoptic endoscopic evaluation to identify silent aspiration Dysphagia 13 19–21 Occurrence Handle1:STN:280:DyaK1c%2FlsVWltA%3D%3D Occurrence Handle9391224
C Madden J Fenton J Hughes C Timon (2000) ArticleTitleComparison between videofluoroscopy in milk-swallow endoscopy in the assessment of swallowing function Clin Otolaryngol 25 IssueID6 504–506 Occurrence Handle10.1046/j.1365-2273.2000.00385.x Occurrence Handle1:STN:280:DC%2BD3M7itVGmtQ%3D%3D Occurrence Handle11122289
NH Zaidi HA Smith SC King C Park PA O’Neill MJ Connolly (1995) ArticleTitleOxygen desaturation in swallowing as a potential marker of aspiration in acute stroke Age Ageing 24 267–270 Occurrence Handle1:STN:280:BymD3c%2FjsFI%3D Occurrence Handle7484479
HA Smith SH Lee PA O’Neill MJ Connolly (2000) ArticleTitleThe combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool Age Ageing 29 495–499 Occurrence Handle10.1093/ageing/29.6.495 Occurrence Handle1:STN:280:DC%2BD3M3htFegtQ%3D%3D Occurrence Handle11191240
PM Zenner DS Losinski RH Mills (1995) ArticleTitleUsing cervical auscultation in the clinical dysphagia examination in long term care Dysphagia 10 27–31 Occurrence Handle10.1007/BF00261276 Occurrence Handle1:STN:280:ByqC28zjs1A%3D Occurrence Handle7859529
Stroud A: To evaluate the reliability of auscultation for the detection of aspiration. Fifth Annual Dysphagia Research Society Meeting, Aspen, CO, November 1996
WJ Logan JF Kavanagh AW Wornall (1967) ArticleTitleSonic correlates of human deglutition J Appl Physiol 23 IssueID2 279–284 Occurrence Handle1:STN:280:CCiB3cvkvFE%3D Occurrence Handle6031197
JAY Cichero BE Murdoch (1998) ArticleTitleThe physiological cause of swallowing sounds: Answers from heart sounds and vocal tract acoustics Dysphagia 13 39–52 Occurrence Handle1:STN:280:DyaK1c%2FlsVWksw%3D%3D Occurrence Handle9391229
K Takahashi ME Groher K Michi (1994) ArticleTitleMethodology for detecting swallowing sounds Dysphagia 9 54–62
Stroud A: Personal communication, Cervical Auscultation Workshop, Derby, England, Spring 2000
DG Altman D Machin TN Bryant MJ Gardner (2000) Statistics with confidence EditionNumber2 BMJ London
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Work performed at Doncaster Royal Infirmary and Royal Hallamshire Hospital, Sheffield, UK.
Rights and permissions
About this article
Cite this article
Shaw, J.L., Sharpe, S., Dyson, S.E. et al. Bronchial Auscultation: An Effective Adjunct to Speech and Language Therapy Bedside Assessment When Detecting Dysphagia and Aspiration?. Dysphagia 19, 211–218 (2004). https://doi.org/10.1007/s00455-004-0008-3
Issue Date:
DOI: https://doi.org/10.1007/s00455-004-0008-3