Within-Bolus Variability of the Penetration-Aspiration Scale Across Two Subsequent Swallows in Patients with Head and Neck Cancer.
Johanna Hedström, Lisa Tuomi, Mats Andersson and 3 others
PMID 28593510WHAT IT FOUND
Swallowing scores in head and neck cancer patients varied widely between two attempts of the same bolus.
Clinicians should not rely on a single swallow or an average score, as this misses unsafe events. Report the worst score to accurately assess aspiration risk.
Key findings
01Group averages showed no significant difference between first and second swallows, but individual scores varied substantially for several bolus types.
02A difference of 5 to 6 points on the Penetration-Aspiration Scale was seen in a small percentage of subjects for thin, mildly thick, and extremely thick liquids.
03Due to high variability, reporting the highest Penetration-Aspiration Scale value is necessary to assess swallowing safety.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Small sample size (38 patients) limits the generalizability of the findings. Patients who aspirated heavily on the first attempt did not perform a second attempt for safety reasons, which may have reduced the observed variability. The study only included patients with abnormal swallowing function (PAS 2 or higher), so results do not apply to patients with normal swallowing. The study was descriptive and did not test whether using the worst score actually improves clinical outcomes like pneumonia rates.
Declared interests
The study was funded by Stiftelsen Assar Gabrielssons Fond, Cancerfonden, and the Research and development council (FoU) SE. No conflicts of interest were declared.
The easy way to misread this
Do not interpret the lack of significant difference in group averages as evidence that swallows are consistent. The study shows that while averages match, individual patients can have large, unsafe variations between two swallows of the same bolus.