Kelly Leonard

Kelly Leonard

Kelly is a senior in the bachelor’s program in Communication Sciences and Disorders. She completed her undergraduate honors thesis under the mentorship of Dr. Emily Plowman and Justine Allen. Kelly is thankful for the guidance and support from her mentors and the other individuals at the Aerodigestive Research Core.

Upon graduation in May, she will continue her studies at the University of Florida in pursuit of a master’s degree in Communication Science and Disorders. Outside of school and work, Kelly enjoys trying local coffee, working out, and cheering on Gator football

Discriminant Ability of the 3 Ounce Water Swallow Test to Detect Aspiration in Cardiac Surgical Patients

Kelly A. Leonard, BHS-CSD

Justine J. Allen, MS, CCC-SLP, BCS-S

Emily K. Plowman, PhD., CCC-SLP


Background: Swallowing impairment (dysphagia) is a common postoperative complication of cardiac surgical procedures leading to significant morbidity and mortality. Currently, a bedside screening to enable early and accurate detection of at-risk individuals has not been identified in the cardiac intensive care unit. We therefore sought to determine the discriminant ability (sensitivity and specificity) of the 3-ounce water swallow test (WST) to detect instrumentally confirmed aspiration in post-surgical cardiac surgical patients.

Methods: One hundred and ninety-seven individuals cardiothoracic surgical patients enrolled in this study and completed the 3-ounce WST and a standardized Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to instrumental confirm aspiration status within 72 hours of extubation. Two independent and blinded raters confirmed swallowing safety using the validated Penetration Aspiration Scale (PAS). Descriptives and a 2×2 contingency table of WST result and aspiration status were performed. Receiver operative curve analysis, sensitivity, specificity, positive and negative predictive value, and overall accuracy of the 3-ounce WST to detect aspiration was performed.

Results: Aspiration was confirmed in 27% (n=54) of patients. Fifty-five percent passed with WST and 45% failed. Sensitivity and specificity of the 3-ounce WST to detect aspiration was 63% and 62% respectively. Positive and negative predictive values were 37% and 82% and overall screening accuracy was 62%.

Conclusions: The WST demonstrated fair discriminant ability to detect aspiration in this cohort of cardiothoracic patients. Although the WST has been validated in other patient settings, it misclassified aspiration status in approximately one-third of cardiothoracic patients who aspirated. These results do not support the use of the WST in isolation in this patient population.

Leonard Poster