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Diagnostic Accuracy of Cervical Auscultation for Aspiration Detection in Adult Dysphagia: Implications for FEES
Nisreen Naser Al Awaji1, Abdullah Mohammed Alfaris2, Shaden Abdulmohsen Alabdulkarim2
1Department of Health Communication Sciences College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University Riyadh Saudi Arabia.
Objectives:
To determine whether cervical auscultation (CA) provides a high-specificity, rule-in bedside signal to prioritize fiberoptic endoscopic evaluation of swallowing (FEES) in adults at risk of aspiration.
Methods:
Single-center, cross-sectional diagnostic-accuracy study in a tertiary hospital. Adults referred for clinically indicated swallow evaluation underwent the same-session, mutually blinded CA (index) and FEES (reference). The unit of analysis was the individual bolus; each bolus received paired CA and FEES ratings. We estimated sensitivity, specificity, predictive values, likelihood ratios (LR±), diagnostic odds ratio (DOR), and area under the ROC curve (AUC), with 95% confidence intervals; McNemar's test compared paired classifications.
Results:
Thirty-two adults contributed 256 analyzable boluses (aspiration prevalence 19.5%). CA sensitivity was 62.0% and specificity 99.5%, with accuracy 92.2%, PPV 96.9%, and NPV 91.5%. LR+ = 127.7 and LR- = 0.38; DOR = 334.5; AUC = 0.808. McNemar's test (FP = 1 vs. FN = 19) was significant, indicating more false negatives than false positives. At pretest probabilities of 10%, 20%, and 40%, a CA-positive result yielded post-test probabilities of 93.4%, 97.0%, and 98.8%, respectively; CA-negative results yielded post-test probabilities of 4.1%, 8.7%, and 20.3%.
Conclusion:
CA offers a high-specificity rule-in signal to triage and prioritize FEES rather than to exclude aspiration. Integrating CA into dysphagia pathways may improve access to instrumental assessment while maintaining safety.
Level Of Evidence:
2 (Diagnosis).
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