Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis

Area of Science:

• Gerontology
• Clinical Medicine
• Diagnostic Accuracy

Background:

• Hospitalizations for aspiration pneumonia are increasing in older adults.
• Bedside water swallow tests (WSTs) offer a potentially efficient and cost-effective screening method.
• Accurate screening is crucial for preventing mortality and comorbidities associated with aspiration.

Purpose of the Study:

• To evaluate the screening accuracy of bedside WSTs for identifying patients at risk of dysphagia-associated aspiration.
• To compare the diagnostic performance of different WST protocols.

Main Methods:

• A systematic literature search was conducted across 16 databases and Google Scholar.
• Included prospective studies involved patients aged 18 years or older undergoing WST.
• WST results were validated against nasoendoscopy or videofluoroscopy; data extraction and quality assessment followed established guidelines.

Main Results:

• Single sip WSTs (1-5 mL) demonstrated 71% sensitivity and 90% specificity.
• Consecutive sips (90-100 mL) showed 91% sensitivity but only 53% specificity.
• Progressively increasing volume WSTs yielded 86% sensitivity and 65% specificity.
• Airway response, particularly with voice changes, enhanced aspiration detection accuracy.

Conclusions:

• Bedside WSTs provide sufficient utility for aspiration screening, though not ideal.
• Large volume, consecutive sip tests effectively ruled out aspiration risk in the absence of overt symptoms.
• Small volume, single sip tests were effective in ruling in aspiration when clinical signs were present.
• Combining WST approaches may improve screening accuracy; further research is recommended.