School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA.
Dysphagia. 2009 Jun;24(2):211-7. doi: 10.1007/s00455-008-9196-6. Epub 2008 Oct 25.
Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin-down posture with thin liquids and head-neutral posture with thickened liquids (nectar-thick and honey-thick consistencies). The subject population included patients with Parkinson's disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all kappa > 0.86) and variable accuracy (range = 69-76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale.
准确检测和分类误吸是视频透视吞咽评估的关键组成部分，这是目前最常用于吞咽障碍诊断和治疗的仪器方法。目前发表的文献表明，根据向临床医生提供的培训量，判断误吸的判断者间可靠性从差到相当好不等。大多数现有研究比较了临床医生之间的判断。没有研究包括在使用姿势补偿策略时进行的判断。本研究旨在检查在识别误吸和使用 8 分渗透/误吸量表时，在医院执业的言语语言病理学家 (SLP) 的判断准确性与未经盲法的专家判断者进行比较。临床医生接受了关于误吸检测的广泛培训，而对渗透/误吸量表的使用接受了最少的培训。视频透视数据是从 669 名患者中收集的，作为一项大型随机临床试验的一部分，包括来自 44 家医院的 76 名临床医生对 11 个州的 10200 次吞咽的判断。在使用吞咽补偿策略时（稀薄液体时低头姿势和浓稠液体时头中立姿势[花蜜稠度和蜂蜜稠度]）对吞咽进行判断。研究对象包括帕金森病和/或痴呆患者。Kappa 统计数据表明，对于 SLP 识别误吸的所有干预措施，其准确性均很高（所有 Kappa > 0.86），与专家判断者相比，使用渗透/误吸量表的准确性也有所不同（范围为 69%-76%）。结论是，虽然 SLP 识别误吸存在的准确性非常高，但建议进行更广泛的培训和/或图像增强，以精确使用渗透/误吸量表。
