Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, 751 South Bascom Ave, San Jose, CA 95128, USA.
PM R. 2012 Apr;4(4):283-9. doi: 10.1016/j.pmrj.2012.01.002.
To assess the accuracy of bedside swallow evaluation (BSE) compared with videofluorosopic swallow study (VFSS) in diagnosing dysphagia in individuals with tetraplegia due to spinal cord injury (SCI).
A prospective diagnostic accuracy study according to STAndards for the Reporting of Diagnostic accuracy studies (STARD) criteria.
A county hospital with acute inpatient SCI unit.
Thirty-nine subjects with SCI and tetraplegia were enrolled. All of the subjects underwent BSE, and 26 subjects completed the VFSS.
Individuals with SCI underwent a BSE followed by a VFSS within 72 hours of the BSE. The subjects were diagnosed as having dysphagia if they had positive findings in either BSE or VFSS.
Sensitivity, specificity, and positive and negative predictive values were calculated by using VFSS as the criterion standard.
Fifteen subjects (38%) were diagnosed as having dysphagia based on the BSE results. Among the subjects who completed the VFSS, 11 were diagnosed with dysphagia (42%) and 4 were diagnosed with aspiration (10%). Of the 26 subjects who completed both BSE and VFSS, only 1 subject was diagnosed differently compared with BSE (3.8%). Different diet recommendations were made in 4 cases after VFSS versus BSE. Different liquid recommendations were made in 8 cases after VFSS versus BSE. Sensitivity of BSE was 100% (95% confidence interval [CI], 71.5%-100%), specificity was 93.3% (95% CI, 68.1%-99.8%). A positive predictive value of BSE was 91.7% (95% CI, 61.5%-100%), and the negative predictive value was 100% (95% CI, 76.8%-100%).
Dysphagia is present in approximately 38% of individuals with acute tetraplegia. Because only one of the 21 subjects was diagnosed differently based on VFSS, we believe that BSE is an appropriate screening tool for dysphagia for individuals with cervical SCI. However, VFSS provided additional information on diet and liquid recommendations, so there appears to be an important clinical role for the VFSS.
评估床边吞咽评估（BSE）与视频荧光吞咽研究（VFSS）在诊断脊髓损伤（SCI）所致四肢瘫痪患者吞咽困难中的准确性。
根据 STAndards for the Reporting of Diagnostic accuracy studies（STARD）标准进行的前瞻性诊断准确性研究。
一家县医院，设有急性 SCI 住院病房。
纳入 39 名 SCI 所致四肢瘫痪患者。所有患者均行 BSE 检查，26 名患者完成 VFSS。
SCI 患者在 BSE 后 72 小时内行 BSE 检查和 VFSS。如果 BSE 或 VFSS 检查结果阳性，则诊断为吞咽困难。
以 VFSS 为标准，计算 BSE 的敏感性、特异性、阳性预测值和阴性预测值。
根据 BSE 结果，15 名患者（38%）被诊断为吞咽困难。在完成 VFSS 的患者中，11 名患者被诊断为吞咽困难（42%），4 名患者被诊断为吸入（10%）。在 26 名完成 BSE 和 VFSS 的患者中，只有 1 名患者的诊断结果与 BSE 不同（3.8%）。与 BSE 相比，VFSS 后有 4 例患者建议采用不同的饮食，8 例患者建议采用不同的液体。BSE 的敏感性为 100%（95%CI，71.5%-100%），特异性为 93.3%（95%CI，68.1%-99.8%）。BSE 的阳性预测值为 91.7%（95%CI，61.5%-100%），阴性预测值为 100%（95%CI，76.8%-100%）。
急性四肢瘫痪患者中约有 38%存在吞咽困难。由于仅 21 名患者中有 1 名根据 VFSS 的诊断结果不同，我们认为 BSE 是颈椎 SCI 患者吞咽困难的一种合适的筛查工具。然而，VFSS 提供了关于饮食和液体推荐的更多信息，因此 VFSS 似乎具有重要的临床作用。
