Aspiration Risk: Clinical Swallow Evaluation and Fiberoptic Endoscopic Evaluation of Swallowing – A Comparative Study

Abstract

Aims and Objectives: Stroke is the most common neurological disorder leading to dysphagia. Aspiration is a frequent and serious complication in patients with dysphagia. Early identification and management of aspiration risk in stroke patients is crucial, as it helps prevent aspiration during oral feeding and reduces associated morbidity and mortality. This study aimed to identify aspiration risk using Clinical Swallow Evaluation (CSE) and compare the results with Fibreoptic Endoscopic Evaluation of Swallowing (FEES), considered the gold standard.
Methods: A total of 49 stroke patients were included. Bedside CSE was performed for each patient, assessing drooling, delayed swallow initiation, abnormal volitional cough, and dysphonia. Cough after swallowing and voice change after swallowing were evaluated using the single water swallow test, scored as present or absent. Delayed swallow initiation was assessed using Logemann’s four-finger method. The CSE scores were then compared with FEES findings for aspiration risk.
Results: The CSE demonstrated a sensitivity of 89.28% and a specificity of 59.09%. The positive predictive value (PPV) was 73.52%, and the negative predictive value (NPV) was 81.25%. The overall accuracy of the CSE was 76%. Among the clinical indicators, cough after swallow showed significant correlation with FEES outcomes.
Conclusion: Clinical evaluation using the six clinical indicators assessed in this study provides a safe and highly sensitive method for identifying aspiration risk at the bedside. While FEES remains the gold standard for objective assessment, CSE offers a fairly accurate alternative when FEES is unavailable. A combined approach using both CSE and FEES may improve diagnostic sensitivity and enhance clinical decision-making.
Keywords: Aspiration Risk, Clinical Swallow Evaluation, Fiberoptic Endoscopic Evaluation of Swallowing