Reliability for detecting oropharyngeal aspiration in children using cervical auscultation

Purpose: Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment.

Method: This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score).

Result: Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79–0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72–0.98). Overall sensitivity was 93.9% (95%CI 91.8–95.6) and specificity was 94.5% (95%CI 92.5–96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone.

Conclusion: Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice.