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

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 (kappa = 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 (kappa = 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. There appears to be a problem of over detection of aspiration. Even in this small study, however, some individual therapists achieve such high reliability (kappa = 0.85) that they must be using successful internal criteria to interpret the swallow sounds correctly and further qualitative research may identify these.