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Original Research: Signs and Symptoms of Chest Diseases |

Novel Bedside Phonetic Evaluation to Identify Dysphagia and Aspiration Risk

Emir Festic, MD; Jose Soto Soto, MD; Lisa A. Pitre, MS; Marilu Leveton, MS; Danielle M. Ramsey, ARNP; William D. Freeman, MD; Michael G. Heckman, MS; Augustine S. Lee, MD
Author and Funding Information

FUNDING/SUPPORT: This study was supported by the Mayo Clinic Florida [CR20 to E. F.].

CORRESPONDENCE TO: Emir Festic, MD, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(3):649-659. doi:10.1378/chest.15-0789
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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 three-component phonetic bedside evaluation. The recordings were scored by two blinded speech-language 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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