SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1576869
This article is part of the Research TopicNew methods in neurorehabilitationView all 11 articles
Diagnostic accuracy of screening tools for silent aspiration in patients with dysphagia: a systematic review and meta-analysis
Provisionally accepted
- West China Hospital, Sichuan University, Chengdu, China
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Background The diagnosis and screening of silent aspiration are crucial for patients with dysphagia. This study aimed to synthesize the evidence and evaluate the diagnostic accuracy of screening tools for silent aspiration in patients with dysphagia. Methods A comprehensive search of 6 databases including Pubmed, Web of Science, CINAHL, Cochrane Library, Scopus, and Embase was conducted from database inception to July 1st, 2024. Meta-analysis was performed on more than three studies. The bivariate mixed effect model was used to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Narrative analysis was applied for studies that could not conduct meta-analysis. Results A total of nine studies were identified, which included six screening tools. Five of these screening tools for silent aspiration were analyzed descriptively. The meta-analysis was conducted to calculate the diagnostic accuracy of cough reflex test (CRT). The combined sensitivity and specificity of CRT were 0.65 (95% CI: 0.38–0.85) and 0.71 (95% CI: 0.63–0.79), respectively. The PLR, NLR, and DOR were 2.27 (95% CI: 1.49–3.47), 0.49 (95% CI: 0.24–0.99), and 4.68 (95% CI: 1.57–13.98), respectively. The area under the SROC curve was 0.73 (95% CI: 0.69–0.77). Conclusions The videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) remain the widely used gold standards for diagnosing silent aspiration. The CRT demonstrates moderate value in diagnosing and predicting silent aspiration. Further studies are needed to compare the diagnostic accuracy and predictive value of the remaining five screening tools for silent aspiration.
Keywords: Silent aspiration, dysphagia, Diagnostic accuracy, Systematic review, Meta-analysis
Received: 14 Feb 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Sun, Cui, Jiang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wen-Yao Cui, West China Hospital, Sichuan University, Chengdu, China
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