Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population

• Published in: CoDAS (São Paulo) Vol. 32; no. 5; p. e20190166
• Main Authors: Lima, Maíra Santilli de, Sassi, Fernanda Chiarion, Medeiros, Gisele Chagas de, Jayanthi, Shri Krishna, Andrade, Claudia Regina Furquim de
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 2020
• Subjects: Adult; Brazil; Deglutition; Deglutition Disorders - diagnosis; Humans; Sensitivity and Specificity; Tracheostomy; Brazil
• ISSN: 2317-1782
• DOI: 10.1590/2317-1782/20202019166

The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population.
The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS).
211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%.
The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.