Department of Neurology, College of Medicine, University of Florida, Jacksonville, Florida 32610-0175, USA.
J Stroke Cerebrovasc Dis. 2010 Jan;19(1):49-57. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.007.
Although many dysphagia screening protocols have been introduced in recent years, no validated, physician-administered dysphagia screening tool exists for acute stroke that can be performed at the bedside. Based on the psychometrically validated Mann Assessment of Swallowing Ability (MASA), we developed the Modified MASA (MMASA) as a physician-administered screening tool for dysphagia in acute stroke.
The purpose of this study was to complete initial validation of this new screening tool for dysphagia in acute ischemic stroke.
Two stroke neurologists independently performed the MMASA on 150 patients with ischemic stroke. Speech-language pathologists performed the standard MASA on all patients. All examiners were blinded to the results of the other assessments. Interjudge reliability was evaluated between the neurologists. Validity between the screening tool (MMASA) and the clinical evaluation (MASA) was assessed with sensitivity/specificity and predictive value assessment.
Interobserver agreement between the neurologists using the MMASA was good (k=0.76; SE=0.082). Based on the comprehensive clinical evaluation (MASA), 36.2% of patients demonstrated dysphagia. Screening results from the neurologists (N1 and N2) identified 38% and 36.7% prevalence of dysphagia, respectively. Sensitivity (N1: 92%, N2: 87%), specificity (N1: 86.3%, N2: 84.2%), positive predictive value (N1: 79.4%, N2: 75.8%), and negative predictive value (N1: 95.3%, N2: 92%) were high between the screen and the comprehensive clinical evaluation.
This preliminary study suggests that the MMASA is a potentially valid and reliable physician-administered screening tool for dysphagia in acute ischemic stroke. Use of this tool may facilitate earlier identification of dysphagia in patients with stroke prompting more rapid comprehensive evaluation and intervention.
近年来已经引入了许多吞咽障碍筛查方案，但仍缺乏一种经过验证的、可由医师在床边进行的用于急性脑卒中的吞咽障碍筛查工具。本研究基于经过心理测量验证的吞咽能力评估量表（MASA），开发了改良 MASA（MMASA）作为一种用于急性脑卒中吞咽障碍的医师管理筛查工具。
本研究旨在初步验证这种新的急性缺血性脑卒中吞咽障碍筛查工具。
两名卒中神经科医生分别对 150 例缺血性脑卒中患者进行 MMASA 检查。言语语言病理学家对所有患者进行标准 MASA 检查。所有检查者均对其他评估结果不知情。评估了神经科医生之间的判断一致性。通过敏感性/特异性和预测值评估，评估了筛查工具（MMASA）与临床评估（MASA）之间的有效性。
使用 MMASA 的神经科医生之间的观察者间一致性良好（k=0.76；SE=0.082）。根据综合临床评估（MASA），36.2%的患者存在吞咽障碍。神经科医生（N1 和 N2）的筛查结果分别显示出 38%和 36.7%的吞咽障碍患病率。敏感性（N1：92%，N2：87%）、特异性（N1：86.3%，N2：84.2%）、阳性预测值（N1：79.4%，N2：75.8%）和阴性预测值（N1：95.3%，N2：92%）在筛检和综合临床评估之间较高。
本初步研究表明，MMASA 是一种潜在有效的、可靠的用于急性缺血性脑卒中吞咽障碍的医师管理筛查工具。使用这种工具可以更快速地识别脑卒中患者的吞咽障碍，从而促使更快速地进行全面评估和干预。
