Poorjavad Marziyeh, Jalaie Shohreh
Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2014 Aug;19(8):776-85.
Oropharyngeal dysphagia following stroke enhances the risk of dehydration, malnutrition, aspiration pneumonia, persistent disablement, and even death. Screening of dysphagia has been shown to positively change health outcomes. The aim of the present study was to systematically introduce the published swallowing screening methods in patients with stroke and their appropriateness for detecting swallowing disorders following stroke with an emphasis on the methodological quality of their research studies.
A computerized search through the Medline (PubMed), Embase, Scopus, and Google Scholar; databases from 1990 through 20 July 2013 was performed. In addition, the related citations and reference lists of the selected articles were considered.
A total of 264 papers were retrieved and 19 articles finally met inclusion criteria. Sixty-eight percent of included papers did not have a sufficient quality and only six articles were scored as having evidence level 'I' and were reported descriptively. The most prevalent bias in the included studies was probably a kind of spectrum bias that could lead to select just a subgroup of admitted stroke patients. The screening tests' sensitivities ranged from 47 to 100%, while their specificities ranged from about 63 to 100%. Strengths and limitations of each test have been discussed.
We ultimately found four simple, valid, reliable, sensitive, and specific tests for screening swallowing disorders in the almost all acute alert stroke patients. Further validation and reliability assessing of screening tests need to follow a very accurate and well-established method in a large sample of the almost all acute alert stroke patients admitted to the hospitals.
中风后口咽吞咽困难会增加脱水、营养不良、吸入性肺炎、持续残疾甚至死亡的风险。吞咽功能筛查已被证明能对健康结果产生积极影响。本研究的目的是系统介绍已发表的中风患者吞咽筛查方法及其在检测中风后吞咽障碍方面的适用性，重点关注其研究的方法学质量。
通过Medline（PubMed）、Embase、Scopus和谷歌学术进行计算机检索；检索了1990年至2013年7月20日的数据库。此外，还考虑了所选文章的相关引用文献和参考文献列表。
共检索到264篇论文，最终19篇文章符合纳入标准。68%的纳入论文质量不足，只有6篇文章被评为证据水平为“I”并进行了描述性报告。纳入研究中最普遍的偏倚可能是一种谱偏倚，可能导致只选择一部分入院中风患者。筛查试验的敏感性范围为47%至100%，特异性范围约为63%至100%。已讨论了每项试验的优缺点。
我们最终找到了四种简单、有效、可靠、敏感且特异的试验，用于筛查几乎所有急性清醒中风患者的吞咽障碍。筛查试验的进一步验证和可靠性评估需要在大量几乎所有入院的急性清醒中风患者样本中遵循非常准确和成熟的方法。
