Clinical prediction of aspiration in acute neurological patients

Glottic dysfunction is a frequent condition in patients with acute neurological diseases: the incidence in stroke patients is between 45-51% increasing mortality three times. The principal complication is aspiration, which demands the involvement of pulmonary physicians and neurologists. The purpose of this study is to evaluate wet voice, water swallow test and cervical auscultation as clinical predictors of aspiration using endoscopical observation as a gold standard. During a period of one year we have prospectively evaluated these tests in acute neurological patients hospitalized in an intensive care unit. Wet voice, 3 oz water swallow test and cervical auscultation demonstrated sensibilities of 66.7, 88.9 and 77.8%, with a respective specificity of 85.2, 59.3 and 77.8%. Positive predictive values were 60, 42.1 and 53.8%, with negative predictive values of 88.5, 94.1 and 91.3% respectively. These results support the utility of clinical aspiration screening as a simple and valuable technique that can be done at the bedside.