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Sensitivity and Specificity of the Yale Swallow Protocol in Recently Extubated Patients.

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  • Additional Information
    • Source:
      Publisher: American Speech-Language-Hearing Association Country of Publication: United States NLM ID: 9114726 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1558-9110 (Electronic) Linking ISSN: 10580360 NLM ISO Abbreviation: Am J Speech Lang Pathol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Rockville Md : American Speech-Language-Hearing Association
    • Subject Terms:
      Deglutition*/physiology ; Deglutition Disorders*/diagnosis ; Deglutition Disorders*/physiopathology ; Deglutition Disorders*/etiology ; Airway Extubation*/adverse effects ; Respiratory Aspiration*/diagnosis ; Respiratory Aspiration*/etiology ; Respiratory Aspiration*/physiopathology; Humans ; Male ; Female ; Middle Aged ; Aged ; Sensitivity and Specificity ; Adult ; Aged, 80 and over ; Fiber Optic Technology ; Predictive Value of Tests ; Reproducibility of Results
    • Abstract:
      Purpose: The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients.
      Method: One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test. Failure was defined as interrupted drinking or immediate cough after drinking. FEES exams were rated using the Penetration Aspiration Scale. Fisher's exact test and t test were used to test for association between failure on the YSP and participant factors (sex, age, reason for admission/intubation, duration of intubation, number of intubations, and time post-extubation of exam), aspiration on FEES and participant factors, and a false negative on the YSP and participant factors.
      Results: Fifty-seven percent (88 of 154) failed the YSP. Fifty percent (77 of 154) of participants aspirated on at least one trial during the FEES. Sensitivity of the YSP was 75%, and specificity was 61%. Participants who failed the YSP were older ( M = 61 years; p = .0030). More women failed the YSP than men ( p = .0007). No patient factors were associated with aspiration on FEES. Participants admitted for respiratory etiologies (pneumonia, chronic obstructive pulmonary disease exacerbation) were most likely to have a false negative on the YSP ( p = .02). False negatives were also more likely in participants with a size ≥ 8 of endotracheal tube ( p = .03).
      Conclusions: The YSP has suboptimal sensitivity and specificity for detecting aspiration in recently extubated patients. More data are needed on predictors of false negatives in order to improve sensitivity and specificity in this critically ill patient population.
    • Publication Date:
      Date Created: 20250127 Date Completed: 20250504 Latest Revision: 20250504
    • Publication Date:
      20250505
    • Accession Number:
      10.1044/2024_AJSLP-23-00449
    • Accession Number:
      39869124