Inter and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia

Objective: To measure the inter and intra-rater reliability of cervical auscultation used alone to detect aspiration in dysphagic patients. Setting: A university teaching hospital. Design: Comparison of the detection of aspiration in 16 recorded swallow sounds by five speech and language therapists...

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Bibliographic Details
Published in:	Clinical rehabilitation Vol. 16; no. 6; pp. 640 - 645
Main Authors:	Stroud, A E, Lawrie, B W, Wiles, C M
Format:	Journal Article
Language:	English
Published:	Thousand Oaks, CA SAGE Publications 01-09-2002 Turpin Arnold
Subjects:	Adult Aged Auscultation - statistics & numerical data Biological and medical sciences Deglutition - physiology Deglutition Disorders - diagnosis Deglutition Disorders - pathology Deglutition Disorders - physiopathology Diagnosis, Differential Digestive system Diseases of the nervous system Female Fluoroscopy Humans Inhalation - physiology Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Observer Variation Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques Pharynx - pathology Pharynx - physiopathology Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Reproducibility of Results Methodology Esophageal disease Cardiovascular disease Swallowing Vascular disease Interrater agreement Complication Dysphagia Neck Diagnosis Cerebrovascular disease Human Nervous system diseases Stroke Auscultation Aspiration Radioscopy Sound Test reliability Cerebral disorder Validity Central nervous system disease Digestive diseases Clinical investigation Technique
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Summary:	Objective: To measure the inter and intra-rater reliability of cervical auscultation used alone to detect aspiration in dysphagic patients. Setting: A university teaching hospital. Design: Comparison of the detection of aspiration in 16 recorded swallow sounds by five speech and language therapists on two occasions. Swallow sounds were recorded simultaneously with videofluoroscopy. Subjects: Sixteen patients referred for assessment of dysphagia with videofluoroscopy. Results: The kappa statistic for multiple raters showed fair agreement between raters (k = 0.28). There was high agreement when aspiration occurred but in non-aspirating swallows there was significant overdetection of aspiration (p < 0.001 McNemar's test). The intra-rater reliability within different individuals was widely variable (k = 0.55 (range 0.31–0.85)). Conclusions: Presented with the swallowing sounds in isolation speech and language therapists cannot reliably classify swallows into those with accompanying aspiration and those without. There appears to be a problem of over detection of aspiration. Even in this small study, however, some individual therapists achieve such high reliability (k = 0.85) that they must be using successful internal criteria to interpret the swallow sounds correctly and further qualitative research may identify these.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0269-2155 1477-0873
DOI:	10.1191/0269215502cr533oa