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2015 ; 10
(4
): 256-65
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Bedside diagnosis of dysphagia: a systematic review
#MMPMID25581840
O'Horo JC
; Rogus-Pulia N
; Garcia-Arguello L
; Robbins J
; Safdar N
J Hosp Med
2015[Apr]; 10
(4
): 256-65
PMID25581840
show ga
Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains
challenging to identify at the bedside. A variety of exam protocols and maneuvers
are commonly used, but the efficacy of these maneuvers is highly variable. We
conducted a comprehensive search of 7 databases, including MEDLINE, Embase, and
Scopus, from each database's earliest inception through June 9, 2014. Studies
reporting diagnostic performance of a bedside examination maneuver compared to a
reference gold standard (videofluoroscopic swallow study or flexible endoscopic
evaluation of swallowing with sensory testing) were included for analysis. From
each study, data were abstracted based on the type of diagnostic method and
reference standard study population and inclusion/exclusion characteristics,
design, and prediction of aspiration. The search strategy identified 38 articles
meeting inclusion criteria. Overall, most bedside examinations lacked sufficient
sensitivity to be used for screening purposes across all patient populations
examined. Individual studies found dysphonia assessments, abnormal pharyngeal
sensation assessments, dual axis accelerometry, and 1 description of water
swallow testing to be sensitive tools, but none were reported as consistently
sensitive. A preponderance of identified studies was in poststroke adults,
limiting the generalizability of results. No bedside screening protocol has been
shown to provide adequate predictive value for presence of aspiration. Several
individual exam maneuvers demonstrated reasonable sensitivity, but
reproducibility and consistency of these protocols was not established. More
research is needed to design an optimal protocol for dysphagia detection.
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