Novel bedside phonetic evaluation to identify dysphagia and aspiration risk

Emir Festic, Jose Soto Soto, Lisa A. Pitre, Marilu Leveton, Danielle M. Ramsey, William D. Freeman, Michael G. Heckman, Augustine S. Lee

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit. METHODS: We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded threecomponent phonetic bedside evaluation. The recordings were scored by two blinded speechlanguage pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short-and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments. RESULTS: Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P .050) and consensus auditory-perceptual evaluation of voice (P .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P .001) and aspiration (AUC, 0.67; P .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P .001). The short-and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different. CONCLUSIONS: Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.

Original languageEnglish (US)
Pages (from-to)649-659
Number of pages11
JournalChest
Volume149
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Phonetics
Deglutition Disorders
Deglutition
Area Under Curve
Phonation
Aspiration Pneumonia
Respiratory Insufficiency
Length of Stay
Patient Care
Nurses
Survival

Keywords

  • Aspiration
  • Dysphagia
  • Phonation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Festic, E., Soto, J. S., Pitre, L. A., Leveton, M., Ramsey, D. M., Freeman, W. D., ... Lee, A. S. (2016). Novel bedside phonetic evaluation to identify dysphagia and aspiration risk. Chest, 149(3), 649-659. https://doi.org/10.1378/chest.15-0789

Novel bedside phonetic evaluation to identify dysphagia and aspiration risk. / Festic, Emir; Soto, Jose Soto; Pitre, Lisa A.; Leveton, Marilu; Ramsey, Danielle M.; Freeman, William D.; Heckman, Michael G.; Lee, Augustine S.

In: Chest, Vol. 149, No. 3, 01.03.2016, p. 649-659.

Research output: Contribution to journalArticle

Festic, E, Soto, JS, Pitre, LA, Leveton, M, Ramsey, DM, Freeman, WD, Heckman, MG & Lee, AS 2016, 'Novel bedside phonetic evaluation to identify dysphagia and aspiration risk', Chest, vol. 149, no. 3, pp. 649-659. https://doi.org/10.1378/chest.15-0789
Festic E, Soto JS, Pitre LA, Leveton M, Ramsey DM, Freeman WD et al. Novel bedside phonetic evaluation to identify dysphagia and aspiration risk. Chest. 2016 Mar 1;149(3):649-659. https://doi.org/10.1378/chest.15-0789
Festic, Emir ; Soto, Jose Soto ; Pitre, Lisa A. ; Leveton, Marilu ; Ramsey, Danielle M. ; Freeman, William D. ; Heckman, Michael G. ; Lee, Augustine S. / Novel bedside phonetic evaluation to identify dysphagia and aspiration risk. In: Chest. 2016 ; Vol. 149, No. 3. pp. 649-659.
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N2 - BACKGROUND: There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit. METHODS: We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded threecomponent phonetic bedside evaluation. The recordings were scored by two blinded speechlanguage pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short-and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments. RESULTS: Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P .050) and consensus auditory-perceptual evaluation of voice (P .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P .001) and aspiration (AUC, 0.67; P .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P .001). The short-and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different. CONCLUSIONS: Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.

AB - BACKGROUND: There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit. METHODS: We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded threecomponent phonetic bedside evaluation. The recordings were scored by two blinded speechlanguage pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short-and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments. RESULTS: Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P .050) and consensus auditory-perceptual evaluation of voice (P .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P .001) and aspiration (AUC, 0.67; P .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P .001). The short-and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different. CONCLUSIONS: Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.

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