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Reliability of the 3-Oz Water Swallow Test Utilizing Cough Reflex As Sole Indicator of Aspiration

HealthEast Bethesda Lutheran Hospital and Rehabilitation Center, St. Paul, Minnesota

Molly Engle

Behavioral Medicine Unit, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama

Charles Ormiston

HealthEast Bethesda Lutheran Hospital and Rehabilitation Center, St. Paul, Minnesota

Objective: Following the publication of the DePippo et al. research, many physicians are beginning to use the 3-oz water screen as a replacement for videofluoroscopic swallow evaluations. Decisions regarding oral intake are being made using the cough reflex as the sole indicator of aspiration. We replicated this procedure in one hundred patients scheduled for videofluoroscopic evaluation to determine its reliability as a screening method.

Design: As part of routine videofluoroscopic swallow evaluations over a four-month period, we identified one hundred consecutive patients tested with the 3-oz water screen.

Setting: The videofluoroscopic evaluations were conducted in an acute hospital set ting and a rehabilitation hospital.

Participants: All patients had observed or suspected swallow difficulty that indicated the need for videofluoroscopic swallow evaluation. Half of the patients were evaluated at the acute hospital, the remaining at the rehabilitation hospital. Males comprised 52%. The mean age was 75.2 years (± 11.3), range 27 to 95. The diagnosis of CVA (left, bilateral, or right) had been made in 50% of the patients.

Main Outcome Measures: Determine the proportion of patients who coughed on the 3-oz screen and aspirated on the videofluoroscopic swallow evaluation.

Results : Fifty-four patients aspirated. Of these, only nineteen (35%) coughed, leaving thirty-five, or 65%, who were not identified by this screening method. Using the Fisher Exact Test, a statistically significant difference (p < 0.005) was identified between those patients who were identified by the 3-oz water screen and those who were iden tified by videofluoroscopic evaluation.

Conclusions: The 3-oz water screen utilizing the cough reflex as the sole indica tor of aspiration is not a replacement for the precision and accuracy of a videofluoro scopic evaluation.

Key Words: Aspiration—Silent aspiration—Cough reflex—Dysphagia swallow screen ing tests—3-oz water swallow screen.

Neurorehabilitation and Neural Repair, Vol. 9, No. 3, 139-143 (1995)
DOI: 10.1177/154596839500900301


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