Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: A systematic review of the evidence

Thuy T Frakking; Anne B Chang; Michael David; Jane Orbell-Smith; Kelly A Weir

doi:10.1111/coa.13402

Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: A systematic review of the evidence

Clin Otolaryngol. 2019 Nov;44(6):927-934. doi: 10.1111/coa.13402. Epub 2019 Oct 8.

Authors

Thuy T Frakking^{1

2}, Anne B Chang^{3

4

5}, Michael David⁶, Jane Orbell-Smith⁷, Kelly A Weir^{8

9}

Affiliations

¹ Speech Pathology Department & Research Development Unit, Metro North Hospital & Health Service, Queensland Health, Caboolture Hospital, Caboolture, QLD, Australia.
² School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
³ Department of Respiratory Medicine, Queensland Children's Hospital, QLD, Australia.
⁴ Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
⁵ Centre for Children's Health Research, Queensland University of Technology, QLD, Australia.
⁶ School of Medicine and Public Health, The University of Newcastle, Gosford, NSW, Australia.
⁷ Library Services, Metro North Hospital & Health Service, Caboolture Hospital, Caboolture, QLD, Australia.
⁸ School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.
⁹ Clinical Governance, Education & Research, Gold Coast University Hospital, Southport, QLD, Australia.

PMID: 31298795
DOI: 10.1111/coa.13402

Abstract

Background: Cervical auscultation (i.e. listening to swallowing sounds) is the most commonly used technique in adjuvant to the clinical feeding examination by speech-language pathologists worldwide to assess for oropharyngeal aspiration risk in children. Despite its relative popularity in clinical practice, little is known on the clinical utility of cervical auscultation within a paediatric population.

Objective: To determine the diagnostic test accuracy of the clinical feeding examination with cervical auscultation in the detection of aspiration in children.

Type of review: Narrative review. Prospero Registration: CRD42017081467 Search strategy: Medline/Pub Med, Embase, CINAHL, AustHealth, Cochrane and UQ (Scopus) were searched up until October 2017. Specifically, the search terms used were: (((oropharyngeal OR respiratory) aspiration) AND (child* OR pediatr* OR paediatr*) and (cervical auscultation OR swallow sounds OR swallowing sounds OR accelerometry OR swallowing acoustics)). The search strategy also included scanning reference lists and citations of retrieved studies.

Evaluation method: Extracted studies were reviewed by two independent reviewers. Methodological quality of studies was assessed using the QUADAS-2 tool.

Results: Only one study met inclusion criteria for this review, which had a bias for flow and timing. Use of cervical auscultation in conjunction with the clinical feeding examination to predict aspiration had a positive predictor value (PPV) of only 0.49 (0.31-0.66), indicating potential over-prediction of aspiration when cervical auscultation is used. In contrast a high NPV of 0.92 (0.78-0.98) was reported indicating that cervical auscultation is useful at ruling out aspiration in children.

Conclusion: This review highlights the paucity of research studies assessing the accuracy of cervical auscultation as an adjuvant to the clinical feeding examination in aspiration detection within the paediatric population.

Keywords: cervical auscultation; child; deglutition; deglutition disorders; oropharyngeal aspiration; systematic review.

Publication types

Systematic Review

MeSH terms

Adolescent
Auscultation*
Child
Child, Preschool
Deglutition Disorders / diagnosis*
Humans
Infant
Infant, Newborn
Neck
Oropharynx*
Respiratory Aspiration / diagnosis*