Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection

Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.

The Clinical Evaluation: A Necessary Tool for the Dysphagia Sleuth

There is controversy about the necessity of clinical (bedside) swallowing examinations. Some argue that screening provides enough information to thoroughly manage a case. In instances in which the risk of an adverse event is very high, screening legitimizes short-term intervention to temporarily mitigate that risk. But comprehensive treatment based on screening is always an unguided and imprecise strategy because screening cannot identify the nature of the problem or the method that best treats the problem. As physicians and public health experts know, the diagnostic process begins with case-finding procedures that predict the presence of risk, and progresses through increasingly precise methods until the clinical problem is resolved. Sometimes the more costly gold standard examination is unnecessary. And sometimes the gold standard test is unavailable because the patient is seen in a system in which the infrastructure and expertise for conducting diagnostic instrumental testing are inaccessible, or because of wait lists, or funding issues. Such situations require the speech-language-pathologist (SLP) to determine how to gather the most and best information available under these constraints. This article will discuss the clinical examinations' role in the diagnostic process and refute the claim that it is unnecessary.