Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: An evaluation of blue dye visualization in cases of known aspiration.

The reliability of the modified Evans blue dye (MEBD) test for the detection of aspirated materials in patients with tracheostomy has been questioned. The videofluoroscopic swallow study (VFSS) has been the standard procedure used to detect aspiration, but there are known risks and the VFSS is not always an available evaluation option for aspiration detection. The purpose of the present study was to investigate the visualization of blue tracheal secretions in cases of known aspiration as documented by the VFSS. Twenty consecutive simultaneous MEBD study and VFSS were completed on patients with tracheostomies at an acute rehabilitation hospital. Overall, the MEBD showed a 50% false-negative error rate. The MEBD identified aspiration in 100% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%).