Department of Neurology, University of Washington, Seattle, Washington, USA.
Stroke. 2012 Mar;43(3):869-71. doi: 10.1161/STROKEAHA.111.638254. Epub 2011 Dec 8.
Swallowing screens after acute stroke identify those patients who do not need a formal swallowing evaluation and who can safely take food and medications by mouth. We conducted a systematic review to identify swallowing screening protocols that met basic requirements for reliability, validity, and feasibility.
We searched MEDLINE and supplemented results with references identified through other databases, journal tables of contents, and bibliographies. All relevant references were reviewed and evaluated with specific criteria.
Of 35 protocols identified, 4 met basic quality criteria. These 4 had high sensitivities of ≥87% and high negative predictive values of ≥91% when a formal swallowing evaluation was used as the gold standard. Two protocols had greater sample sizes and more extensive reliability testing than the others.
We identified only 4 swallowing screening protocols for patients with acute stroke that met basic criteria. Cost-effectiveness of screening, including costs associated with false-positive results and impact of screening on morbidity, mortality, and length of hospital stay, requires elucidation.
急性脑卒中后进行吞咽筛查,可以识别出那些不需要进行正式吞咽评估、可以安全经口进食和服药的患者。我们进行了一项系统评价,以确定符合可靠性、有效性和可行性基本要求的吞咽筛查方案。
我们检索了 MEDLINE,并通过其他数据库、期刊目录和参考文献补充了结果。所有相关参考文献均经过专门的标准进行了审查和评估。
在确定的 35 个方案中,有 4 个符合基本质量标准。当正式吞咽评估作为金标准时,这 4 个方案的敏感度均≥87%,阴性预测值均≥91%。有 2 个方案的样本量更大,可靠性测试更广泛。
我们仅确定了 4 个符合基本标准的急性脑卒中患者吞咽筛查方案。需要阐明筛查的成本效益,包括假阳性结果的相关成本以及筛查对发病率、死亡率和住院时间的影响。