Artigo Original

Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population 

Precisão diagnóstica para o risco de broncoaspiração em população heterogênea

Maíra Santilli de Lima; Fernanda Chiarion Sassi; Gisele Chagas de Medeiros; Shri Krishna Jayanthi; Claudia Regina Furquim de Andrade

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Purpose: The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. Method: The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital’s medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). Results: 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. Conclusion: The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.


Deglutition, Deglutition Disorders, Triage, Protocols, Validation Studies, Sensitivity and Specificity


Objetivo: O objetivo do presente estudo foi realizar a validação de um instrumento simples de triagem da disfagia utilizado em um hospital público de grande porte no Brasil em população adulta heterogênea. Método: O Protocolo de Avaliação de Risco para Disfagia versão de triagem (PARDt) contém quatro itens (ausculta cervical alterada, alteração da qualidade vocal, tosse e engasgo antes/durante/após a deglutição) que foram previamente indicados como fatores de risco independentes associados à presença de disfagia no teste de deglutição com água. Fonoaudiólogos treinados administraram e classificaram o PARDt para pacientes consecutivos encaminhados pela equipe médica do hospital para realizar a videofluoroscopia da deglutição (VDF). Resultados: 211 pacientes foram submetidos ao PARDt: 99 falharam e 112 passaram. Um em cada cinco pacientes foram randomicamente selecionados para VDF. O PARDt apresentou excelente validade: sensibilidade de 92,9%; especificidade de 75,0%; valores preditivos negativos de 95,5%; acurácia de 80,9%. Conclusão: O PARDt é uma ferramenta simples e precisa para identificar o risco de penetração e/ou aspiração em pacientes que não são alimentados por sonda, que apresentam bom nível de alerta, sem histórico de pneumonias de repetição, que não estejam em vigência de pneumonia e que não façam uso de cânula de traqueostomia. 


Deglutição, Transtornos de Deglutição, Triagem, Protocolos, Estudos de Validação, Sensibilidade e Especificidade


Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML, El-Koussy M, Kägi G, Jung S, Sarikaya H. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLOS One. 2016.

Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665-73.

Clave P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806-15.

Cook IJ, Kahrilas PJ. American Gastroenterological Association technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(3):455-78.

Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in hospitalized patient. Arch Otolaryngol. 2010;136(8):784-9.

Rainer W, Pourhassan M, Streicher M, Hiesmayr M, Schindler K, Sieber CC, Volkert D. Impact of dysphagia on mortality of nursing home residents: results from the nutrition day project. JAMA Dir Assoc. 2018.

Nakashima T, Maeda K, Tahira K, Taniguchi K, Mori , Kiyomiya H, Akagi J. Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals. Geriatr Gerontol Int. 2018.

Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29:545-52.

Moraes DP, Sassi FC, Mangilli LD, Zilberstein B, Andrade CRF. Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients. Crit Care. 2013;17(5):R243.

Wilson RD, Howe EC. A cost-effectiveness analysis of screening methods for dysphagia after stroke. PM&R. 2011;4:273-82.

Stoeckli SJ, Huisman TA, Seifert B, Martin-Harris BJ. Interrater reliability of videofluoroscopy swallow evaluation. Dysphagia. 2003;18(1):53-7.

Almirall J, Cabre M, Clave P. Aspiration pneumonia. Med Clin. 2007;129:424-32.

Brown CVR, Hejl K, Mandaville AD, Chaney PE, Stevenson G, Smith C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care. 2011;26:108.e 9-13.

Donovan NJ, Daniels SK, Edmiastron J, Weinhardt J, Summers D, Mitchell PH. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke. 2013;44:e24-31.

Carnaby-Mann G, Lenius K, Crary MA. Update on assessment and management of dysphagia post stroke. Northeast Florida Medicine Journal. 2007;58(1):31-4.

Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: a systematic review. Ci Ji Yi Xue Za Zhi. 2016;28:41-8.

Fedder WN. Review of evidence-based nursing protocols for dysphagia assessment. Stroke. 2017;48:e99-e101.

Sassi FC, Medeiros GC, Zilberstein B, Jayanthi SK, Andrade CRF. Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings. CLINICS. 2017;72(12):718-22.

Edmiaston J, Connor LT, Steger-May K, Ford A. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc. 2014;23(4):712-6.

Martino RM, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside Screening Test (TOR-BSST). Development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40(2):555-61.

Padovani AR, Moraes DP, Mangilli LD, Andrade CRF. Protocolo fonoaudiológico de avaliação do risco para disfagia (PARD). Rev Soc Bras Fonoaudiol. 2007;12:199-205.

Medeiros GC, Sassi FC, Mangilli LD, Zilberstein B, Andrade CRF. Clinical dysphagia risk predictors after prolonged orotracheal intubation. CLINICS. 2014;69(1):8-14.

Ertekin C, Aydogdu I, Yuceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosur Ps. 1996;61(5):491-6.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration aspiration scale. Dysphagia. 1996;11:93-8.

Keage M, Delatychi M, Corben L, Vogel A. A systematic review of self-reported swallowing assessments in progressive neurological disorders. Dysphagia. 2015;30:27-46.

Sarabia-Cobo CM, Perez V, de Lorena P, Dominguez E, Hermosilla C, Nunez MJ, Vigueiro M, Rodríguez L. The incidence and prognostic implications of dysphagia in elderly patients institutionalized: a multicenter study in Spain. Appl Nurs Res. 2016;30:6-9.

Jang DH, Choi KH, Kim DH, Lim CM, Kim JS. Comparison between the radionuclide salivagram and videofluoroscopic swallowing study methods for evaluating patients with aspiration pneumonia. Ann Nucl Med. 2013;27:247-52.

Butler SG, Stuart A, Markley L, Feng X, Kritchevsky SB. Aspiration as function of age, sex, liquid type, bolus volume, and bolus delivery across the healthy adult life span. Ann Oto Rhinol Laryn. 2018;127(1):21-32.

Wang CM, Chen JY, Chuang CC, Tseng WC, Wong AMK, Pei YC. Aging-related changes in swallow, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques. Geriatr Gerontol Int. 2015;15:736-44.

Dudik JM, Korusu A, Coyle JL, Sejdic E. A statistical analysis of cervical auscultation signals from adults with unsafe airway protection. J NeuroEng Rehabil. 2016;13:7.

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