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The accuracy of the modified Evan's blue dye test in detecting aspiration in tracheostomised patients

  • T A Linhares Filho (a1), F P N Arcanjo (a1), L H Zanin (a2), H A Portela (a2), J M Braga (a2) and V da Luz Pereira (a2)...



To evaluate the sensitivity and specificity of the modified Evans blue dye test compared to the fibre-optic endoscopic evaluation of swallowing to detect aspiration in tracheostomised patients.


This observational accuracy study included 17 patients hospitalised for respiratory complications, subjected to prolonged intubation, and for this reason, tracheostomised.


Mean patient age was 60.2 ± 21.0 years. Aspiration was identified in 10 patients when assessed by fibre-optic endoscopic evaluation of swallowing; of these, 1 had aspiration when evaluated by modified Evans blue dye test. The dye test had a sensitivity of 10.0 per cent and specificity of 100.0 per cent for detecting aspiration. Fibre-optic endoscopic evaluation of swallowing revealed no statistically significant associations between aspiration presence and: speech and language therapy duration, intubation time, or tracheostomy plus mechanical ventilation duration.


The modified Evans blue dye test is simple and inexpensive, and does not require prior knowledge in endoscopy; it may be used as an initial screening test in all tracheostomised patients for evaluating aspiration. However, fibre-optic endoscopic evaluation of swallowing should be used for a more comprehensive diagnosis of tracheostomy patients, especially for those at high risk for aspiration.


Corresponding author

Author for correspondence: Dr Francisco Plácido Nogueira Arcanjo, Av. Comandante Maurocélio Rocha Ponte, 100 – Derby, 62.042-280 – Sobral-CE, Brazil E-mail: Fax: +55 88 3677 8000


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Dr F P N Arcanjo takes responsibility for the integrity of the content of the paper



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1Simão, MA, Alacid, CAN, Rodrigues, KA, Albuquerque, C, Furkim, AM. Incidence of tracheal aspiration in tracheostomized patients in use of mechanical ventilation. Arq Gastroenterol 2009;46:311–14
2Brady, SL, Hildner, CD, Hutchins, BF. Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: an evaluation of blue dye visualization in cases of known aspiration. Dysphagia 1999;14:146–9
3Belafsky, PC, Blumenfeld, L, Lepage, A, Nahrstedt, K. The accuracy of the modified Evan's blue dye test in predicting aspiration. Laryngoscope 2003;113:1969–72
4Ajemian, MS, Nirmul, GB, Anderson, MT, Zirlen, DM, Kwasnik, EM. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg 2001;136:434–7
5Warnecke, T, Suntrup, S, Teismann, IK, Hamacher, C, Oelenberg, S, Dziewas, R. Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients. Crit Care Med 2013;41:1728–32
6Winklmaier, U, Wust, K, Plinkert, PK, Wallner, F. The accuracy of the modified Evans blue dye test in detecting aspiration in head and neck cancer patients. Eur Arch Otorhinolaryngol 2007;264:1059–64
7Thompson-Henry, S, Braddock, B. The modified Evan's blue dye test procedure fails to detect aspiration in the tracheostomized patient: five case reports. Dysphagia 1995;10:172–4
8Donzelli, J, Brady, S, Wesling, M, Craney, M. Simultaneous modified Evans blue dye procedure and video nasal endoscopic evaluation of the swallow. Laryngoscope 2001;111:1746–50
9Meyers, AD. The modified Evan's blue dye procedure in the tracheostomized patient. Dysphagia 1995;10:175–6
10Langmore, SE, Schatz, K, Olsen, N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988;2:216–19
11Hiss, SG, Postma, GN. Fiberoptic endoscopic evaluation of swallowing. Laryngoscope 2003;113:1386–93
12Aviv, JE, Murry, T, Zschommler, A, Cohen, M, Gartner, C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1.340 consecutive examinations. Ann Otol Rhinol Laryngol 2005;114:173–6
13Langmore, SE, Schatz, K, Olson, N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol 1991;100:678–81
14Cameron, JL, Reynolds, J, Zuidema, GD. Aspiration in patients with tracheostomies. Surg Gynecol Obstet 1973;136:6870
15Terk, AR, Leder, SB, Burrell, MI. Hyoid bone and laryngeal movement dependent upon presence of a tracheotomy tube. Dysphagia 2007;22:8993


The accuracy of the modified Evan's blue dye test in detecting aspiration in tracheostomised patients

  • T A Linhares Filho (a1), F P N Arcanjo (a1), L H Zanin (a2), H A Portela (a2), J M Braga (a2) and V da Luz Pereira (a2)...


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