CLINICS

Clinics (Sao Paulo). 2017 December; 72(12): 718-722.
doi:10.6061/clinics/2017(12)01

Copyright © 2017 CLINICS

Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings

Fernanda C. Sassi I , Gisele C. Medeiros II , Bruno Zilberstein III , Shri Krishna Jayanthi IV , Claudia R.F. de Andrade I *

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR

Divisão de Fonoaudiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

Divisao de Cirurgia Digestiva, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

*Corresponding author. E-mail: clauan@usp.br

received March 15, 2017; revised March 27, 2017; accepted August 15, 2017.

Abstract

OBJECTIVES:

To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol.

METHODS:

A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values.

RESULTS:

The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. “Cough” and “wet-hoarse” vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk.

CONCLUSION:

The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.

Keywords: Dysphagia, Screening Test, Modified Barium Swallow, Aspiration, Pneumonia


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