Thicker is better? Impact of food consistencies on aspiration detection using IDDSI levels

Ming-Yen Hsiao; Wen-Hsuan Tseng; Kao-Ming Lee; Chien-Hui Cheng; Hui-Chuen Chen; Tyng-Guey Wang

doi:10.1016/j.jfma.2024.11.005

Thicker is better? Impact of food consistencies on aspiration detection using IDDSI levels

J Formos Med Assoc. 2024 Nov 20:S0929-6646(24)00521-7. doi: 10.1016/j.jfma.2024.11.005. Online ahead of print.

Authors

Ming-Yen Hsiao¹, Wen-Hsuan Tseng², Kao-Ming Lee³, Chien-Hui Cheng⁴, Hui-Chuen Chen⁴, Tyng-Guey Wang⁵

Affiliations

¹ Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA.
³ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Dietetic, National Taiwan University Hospital, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: tgw@ntu.edu.tw.

PMID: 39572269
DOI: 10.1016/j.jfma.2024.11.005

Abstract

Background/purpose: Water is the most commonly, and often the only tested material in swallow screening. Our objective is to assess the impact of food consistencies on the reliability of trial swallows in predicting aspiration in dysphagic patients, utilizing the International Dysphagia Diet Standardisation Initiative (IDDSI) levels.

Methods: All trial swallows were evaluated using 5 ml of standardized test food with IDDSI levels of 0, 2, 4, 5. The flexible endoscopic evaluation of swallowing was used as the basis for comparison. The sensitivity, specificity, and predictive values of commonly used direct clinical signs for the detection of aspiration were analyzed, including cough with swallow (choking) and post-swallow voice change (wet voice).

Results: IDDSI 2 test food demonstrated the highest accuracy for detecting aspiration when using both clinical signs of cough (91%) and wet voice (83%). Despite reduced risk of aspiration, the percentage of silent aspiration among aspirators was significantly higher when tested with higher IDDSI levels of test food.

Conclusion: The diagnostic accuracy of commonly-used clinical signs for the indication of aspiration is significantly affected by food consistency. Test foods with varying consistencies, particularly those at IDDSI level 2, should be considered during clinical swallow examinations, especially for screening purposes.

Keywords: Aspiration; Clinical swallow examination; Dysphagia; International dysphagia diet Standardisation initiative.