Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation.
Kathleen Webler, Julia Carpenter, Valerie Hamilton and 2 others
PMID 34757074WHAT IT FOUND
Longer intubation increases the odds of airway invasion during swallowing, with each extra day raising the odds by 15%.
Clinical bedside swallow exams often miss silent aspiration. Instrumental assessments like VFSS are needed to safely guide diet upgrades in post-COVID inpatient rehabilitation.
Key findings
01For each additional day of intubation, the odds of having a penetration aspiration score of 3 or greater increased by approximately 15%.
02The Mann Assessment of Swallowing Ability (MASA) was a poor predictor of aspiration, with 50% of patients who aspirated achieving an 'unlikely to aspirate' likelihood ratio.
03Only 20% of patients had been evaluated with videofluoroscopy in acute care, yet 93% were receiving modified diets, indicating conservative management without instrumental confirmation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was retrospective and relied on clinical documentation rather than research-grade measures. The sample size was small (40 patients) and taken early in the pandemic, which may not reflect current patient populations or management practices. The timing of the VFSS relative to admission or discharge was not analyzed. Factors influencing FOIS scores other than dysphagia, such as dentition issues, were not tracked.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health (NIH).
The easy way to misread this
Do not assume that a normal score on a clinical bedside swallow exam (MASA) rules out aspiration. In this study, half of the patients who aspirated on VFSS were rated as 'unlikely to aspirate' on the clinical exam, so instrumental assessment is required for definitive diagnosis.