Mann G, Hankey G J, Cameron D
Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia.
Cerebrovasc Dis. 2000 Sep-Oct;10(5):380-6. doi: 10.1159/000016094.
We prospectively examined 128 patients with acute first-ever stroke to determine the prevalence of swallowing disorders, the diagnostic accuracy of our clinical assessment of swallowing function compared with videofluoroscopy, and interobserver agreement for the clinical and videofluoroscopic diagnosis of swallowing disorders and aspiration. We found clinical and videofluoroscopic evidence of a swallowing disorder in 51% [95% confidence interval (CI) 42-60%] and 64% (95% CI 55-72%) of patients, respectively, and aspiration in 49% (95% CI 40-58%) and 22% (95% CI 15-29%) of patients, respectively. The optimal clinical criteria for detecting videofluoroscopic evidence of a swallowing disorder and aspiration were any clinical evidence of a swallowing disorder (sensitivity 73%, 95% CI 62-82%; specificity 89%, 95% CI 76-96%), and any clinical evidence of aspiration (sensitivity 93%, 95% CI 76-99%; specificity 63%, 95% CI 53-72%). The interobserver agreement between two speech pathologists for the clinical diagnosis of a swallowing disorder (kappa: 0.82 +/- 0.09) and aspiration (kappa: 0.75 +/- 0.09) was good, and between a speech pathologist and radiologist for the videofluoroscopic diagnosis of a swallowing disorder (kappa: 0.75 +/- 0.09) and aspiration (kappa: 0.41 +/- 0.09), it was good and fair, respectively. Although clinical bedside examination underestimates the frequency of swallowing abnormalities and overestimates the frequency of aspiration compared with videofluoroscopy, it may still offer valuable information for the diagnosis of swallowing impairment. Long-term follow-up studies are required to determine the independent functional significance of the findings of the bedside and videofluoroscopic examinations in predicting the occurrence of important outcome events such as aspiration pneumonia.
我们前瞻性地研究了128例首次发生急性卒中的患者，以确定吞咽障碍的患病率、我们对吞咽功能的临床评估与电视荧光吞咽造影检查相比的诊断准确性，以及不同观察者之间对吞咽障碍和误吸的临床及电视荧光吞咽造影诊断的一致性。我们分别在51%[95%置信区间（CI）42 - 60%]和64%（95%CI 55 - 72%）的患者中发现了吞咽障碍的临床及电视荧光吞咽造影证据，分别在49%（95%CI 40 - 58%）和22%（95%CI 15 - 29%）的患者中发现了误吸。检测吞咽障碍和误吸的电视荧光吞咽造影证据的最佳临床标准分别为任何吞咽障碍的临床证据（敏感性73%，95%CI 62 - 82%；特异性89%，95%CI 76 - 96%）和任何误吸的临床证据（敏感性93%，95%CI 76 - 99%；特异性63%，95%CI 53 - 72%）。两位言语病理学家对吞咽障碍（kappa值：0.82±0.09）和误吸（kappa值：0.75±0.09）的临床诊断的观察者间一致性良好，而对于言语病理学家和放射科医生对吞咽障碍（kappa值：0.75±0.09）和误吸（kappa值：0.41±0.09）的电视荧光吞咽造影诊断，观察者间一致性分别为良好和中等。尽管与电视荧光吞咽造影检查相比，临床床旁检查低估了吞咽异常的频率并高估了误吸的频率，但它仍可为吞咽功能损害的诊断提供有价值的信息。需要进行长期随访研究，以确定床旁检查和电视荧光吞咽造影检查结果在预测诸如误吸性肺炎等重要结局事件发生方面的独立功能意义。
