Inter and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia

TLDR: There appears to be a problem of over detection of aspiration in dysphagic patients and some individual therapists achieve such high reliability that they must be using successful internal criteria to interpret the swallow sounds correctly and further qualitative research may identify these.

Abstract: Objective: To measure the inter and intra-rater reliability of cervical auscultation used alone to detect aspiration in dysphagic patients.Setting: A university teaching hospital.Design: Comparison of the detection of aspiration in 16 recorded swallow sounds by five speech and language therapists on two occasions. Swallow sounds were recorded simultaneously with videofluoroscopy.Subjects: Sixteen patients referred for assessment of dysphagia with videofluoroscopy.Results: The kappa statistic for multiple raters showed fair agreement between raters (k = 0.28). There was high agreement when aspiration occurred but in non-aspirating swallows there was significant overdetection of aspiration (p < 0.001 McNemar's test). The intra-rater reliability within different individuals was widely variable (k = 0.55 (range 0.31–0.85)).Conclusions: Presented with the swallowing sounds in isolation speech and language therapists cannot reliably classify swallows into those with accompanying aspiration and those without. Th...