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Reliability and validity of cervical auscultation: a controlled comparison using videofluoroscopy
Paula Leslie1, Michael J Drinnan, Paul Finn
1School of Surgical and Reproductive Sciences, The Medical School, University of Newcastle, Newcastle-upon-Tyne, United Kingdom. Paula.Leslie@newcastle.ac.uk
Dysphagia
|January 26, 2005
Summary
Cervical auscultation for swallowing assessment shows poor rater reliability, impacting clinical value. Group consensus improved accuracy, suggesting audible cues in swallow sounds hold potential for reliable classification.
Area of Science:
- Speech-language pathology
- Clinical audiology
- Diagnostic techniques
Background:
- Cervical auscultation is a clinical swallowing assessment tool.
- Its evidence base is limited, and its interpretation is controversial.
- This study investigates if interpretation relies on actual sounds or external information.
Purpose of the Study:
- To determine rater reliability in cervical auscultation.
- To assess the impact of reliability on clinical value.
- To compare cervical auscultation judgments with videofluoroscopy.
Main Methods:
- Computer recording of swallow sounds using a stethoscope.
- Sampling sounds from healthy and patient swallows during videofluoroscopy.
- Classification of sound clips by experienced speech-language pathologists (SLPs).
Main Results:
- Intrarater reliability varied widely (kappa -0.12 to 0.71).
- Interrater reliability was poor (kappa = 0.17).
- Comparison with videofluoroscopy showed 66% specificity and 62% sensitivity; consensus improved this to 90% specificity and 80% sensitivity.
Conclusions:
- Individual rater reliability in cervical auscultation is highly variable.
- Poor reliability limits the technique's validity and clinical value.
- Group consensus demonstrates potential for accurate swallow sound classification, indicating audible cues exist.