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.
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References
1.
Wiles CM. Neurogenic dysphagia. J Neurol Neurosurg Psychiatry1991;54:1037-1039.
2.
Gordon C, Langton Hewer R, Wade DT. Dysphagia in acute stroke. BMJ1987;295:411-414.
3.
Langmore SE, Terpenning MS, Schork A et al. Predictors of aspiration:how important is dysphagia?Dysphagia1998;13:69-81.
4.
McCullough GH, Rosenbek JC, Robbins JA, Coyle JL, Wood JL. Ordinality and intervality of a penetration-aspiration scale. J Med Speech-Pathol1998;6:65-72.
5.
Jones B. The pharynx:disorders of function. Radiol Clin North Am1994;32:1103-1115.
6.
Scott A, Perry A, Bench J. A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia1998;13:223-227.
7.
Selley WG, Flack F, Ellis RE, Brooks WA. Respiratory patterns associated with swallowing:Part The normal adult pattern and changes with age. Age Ageing1989;18:168-172.
8.
Zenner PM, Losinski DS, Mills RH. Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia1995;10:27-31.
9.
Eicher PS, Manno CJ, Fox CA, Kerwin ME. Impact of cervical auscultation on accuracy of clinical evaluation in predicting penetration/aspiration in a paediatric population. In:Groher M ed. Second workshop on cervical auscultation. Tyson's Corner, McLean, Virginia:Michael Groher, 1994:28-32.
10.
McCullough GH, Rosenbek JC, Robbins JA, Coyle JL, Wood JL. Ordinality and intervality of a penetration-aspiration scale. J Med Speech Pathol1998;6:65-72.
11.
Fleiss JL. Statistical methods for rates and proportions, second edition. New York:John Wiley, 1981.
12.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics1977;33:159-174.
13.
Teasell RW, McRae M, Marchuk Y, Finestone HM. Pneumonia associated with aspiration following stroke. Arch Phys Med Rehabil1996;77:707-709.
14.
Groher M. The role of the speech-language pathologist in the evaluation and care of oral and pharyngeal dysphagia. J Neuro Rehabil1992;3:5-8.
15.
Hamlet S, Penney DG, Formolo J. Stethoscope acoustics and cervical auscultation of swallowing. Dysphagia1994;9:63-68.
16.
Takahashi K, Uyama R, Groher M, Michi K. A new method for detecting dysphagic swallows using acoustic characteristics of soft expiratory sounds. Dysphagia1997;12:115-115.
