Accuracy of Visual Inspection of Thickened Liquids: Implications for Multidisciplinary Dysphagia Management and Clinical Nutrition.

INTRODUCTION

To evaluate the accuracy of visually estimating thickened liquid volume via video-observed conditions and to determine whether clinical experience or thickener composition influences judgement reliability.

METHODS

A cross-sectional online survey was administered to 57 practising speech-language pathologists (SLPs) and 50 postgraduate SLP students. Participants viewed four 12-s videos of fluids prepared to explicit International Dysphagia Diet Standardisation Initiative consistencies (Levels 1, 2 and 4) using starch and xanthan gum thickeners. Participants estimated the volumetric amount of thickener (in product-specific scoops) added to each sample.

RESULTS

Overall accuracy was low, with no significant difference between students (49.5%) and practitioners (47.4%) (p = 0.60). Combined cohort analysis showed that years of clinical practice alone were not associated with improved fluid estimation accuracy (p = 0.38). Students significantly outperformed practitioners in identifying Level 4 starch-based liquids (88.0% vs. 68.4%, p = 0.028) but were inaccurate in identifying Level 4 xanthan gum-based liquids (2.0% vs. 29.8%, p < 0.001).

CONCLUSION

Visual fluid estimation via video is highly variable, and clinical experience alone was not associated with improved accuracy in this cohort. To optimise patient safety and prevent secondary complications like dehydration from over-thickening, multidisciplinary teams should supplement subjective clinical judgement with objective ways to ensure patients are receiving the appropriate level of thickened liquids.