eTWST: An Extension to the Timed Water Swallow Test for Increased Dysphagia Screening Accuracy.
Louise Brage, Fredrik Nylén, Patricia Hägglund and 1 others
PMID 39521747WHAT IT FOUND
Separate speed cutoffs for men and women, plus coughing or a wet or gurgly voice, made the water swallow screen predict dysphagia on FEES better than the original 10 mL/s cutoff.
Key findings
01The eTWST identified dysphagia with sensitivity 70% and specificity 72%, and identified aspiration with sensitivity 92% and specificity 62%.
02The original TWST at a 10 mL/s cutoff identified dysphagia with sensitivity 45% and specificity 80%, and the eTWST was superior to it in this sample.
03The eTWST indicates dysphagia when swallowing capacity is below 6 mL/s in women or 13 mL/s in men, or when clinical signs appear in intermediate ranges.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was done in one Swedish hospital setting, and the authors note that the eTWST may transfer less reliably to other samples of advanced ages. FEES was the reference standard, but the study did not evaluate FEES rater reliability. The extended rule was developed and evaluated in the same 196 participants. The sample included 127 healthy adults and 69 patients referred for FEES, so it does not show performance in a general screening population. Two of 198 eligible people were excluded because they did not consent to FEES.
Declared interests
Umea University funded the work. No additional conflict-of-interest statement is provided.
The easy way to misread this
Do not use eTWST instead of FEES or VFS. In this study, eTWST identified dysphagia with sensitivity 70% and specificity 72%, so it is a screening rule, not a diagnosis.