Institute of Neuroepidemiology and Tropical Neurology, Limoges, EA 3174, Faculty of Medicine, University of Limoges, Limoges, France.
Eur J Phys Rehabil Med. 2011 Sep;47(3):441-6. Epub 2011 Apr 20.
Swallowing disorders are common and serious problems post stroke. Physical signs and ingestion test consist of main approaches of bedside screening of aspiration.
To assess the composability of these approaches.
A pilot study to develop a combined schema; secondly a validation study of this schema.
Inpatient of Neurology Department and of Rehabilitation Department.
Forty-one patients post acute stroke included in the pilot study; 107 patients of subacute stroke for validation study.
In pilot study, patients were assessed using Clinical Predicative Scale of Aspiration (CPSA) and 3-ounce Water swallow Test (3oz WT). Videofluoroscopic examination (VFSE) was performed as gold standard when the results of screening were discordant. In validation study, swallowing disorders were assessed systematically using CPSA, 3 oz WT and VFSE.
The combined screening schema, Practical Aspiration Screening Scheme (PASS), consisted of a 3oz WT to enhance results of the uncertain range of CPSA. Validation study showed that sensitivity and specificity of the 3oz WT were 87.3% and 42.3% respectively; those of CPSA were 50.1% and 50.0%, with a range of uncertainty in 42.6% of patients. The sensitivity of PASS was 89.1%, comparable to that of the 3oz WT, while the specificity of PASS was 80.8%, significantly higher than that of single tests. PASS also reduced systematic recourse to VFSE with a substantial agreement with it (kappa=0.7).
Physical signs and ingestion test are complementary in the screening of aspiration.
Combined schema enhances the efficiency of bedside screening of aspiration.
吞咽障碍是脑卒中后常见且严重的问题。体格检查和吞咽测试是床边吸入风险筛查的主要方法。
评估这些方法的组合性能。
首先开发一种综合方案的初步研究，然后是该方案的验证研究。
神经内科和康复科的住院病房。
纳入初步研究的 41 例急性脑卒中患者；纳入验证研究的 107 例亚急性脑卒中患者。
在初步研究中，使用临床预测性误吸量表（CPSA）和 3 盎司水吞咽测试（3ozWT）对患者进行评估。当筛查结果不一致时，以视频透视检查（VFSE）作为金标准。在验证研究中，使用 CPSA、3ozWT 和 VFSE 对吞咽障碍进行系统评估。
联合筛查方案，实用误吸筛查方案（PASS），由 3ozWT 增强 CPSA 不确定范围的结果。验证研究表明，3ozWT 的敏感性和特异性分别为 87.3%和 42.3%；CPSA 的敏感性和特异性分别为 50.1%和 50.0%，42.6%的患者处于不确定范围。PASS 的敏感性为 89.1%，与 3ozWT 相当，而 PASS 的特异性为 80.8%，明显高于单项测试。PASS 还减少了对 VFSE 的系统使用，并与 VFSE 具有实质性一致性（kappa=0.7）。
体格检查和吞咽测试在吸入风险筛查中具有互补性。
综合方案提高了床边吸入风险筛查的效率。
