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颈部听诊在吞咽困难诊断中的可靠性和有效性:一项系统评价。

The reliability and validity of cervical auscultation in the diagnosis of dysphagia: a systematic review.

作者信息

Lagarde Marloes L J, Kamalski Digna M A, van den Engel-Hoek Lenie

机构信息

Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands

University Medical Center Utrecht, The Netherlands.

出版信息

Clin Rehabil. 2016 Feb;30(2):199-207. doi: 10.1177/0269215515576779. Epub 2015 Mar 19.

Abstract

OBJECTIVE

To systematically review the available evidence for the reliability and validity of cervical auscultation in diagnosing the several aspects of dysphagia in adults and children suffering from dysphagia.

DATA SOURCES

Medline (PubMed), Embase and the Cochrane Library databases.

REVIEW METHODS

The systematic review was carried out applying the steps of the PRISMA-statement. The methodological quality of the included studies were evaluated using the Dutch 'Cochrane checklist for diagnostic accuracy studies'.

RESULTS

A total of 90 articles were identified through the search strategy, and after applying the inclusion and exclusion criteria, six articles were included in this review. In the six studies, 197 patients were assessed with cervical auscultation. Two of the six articles were considered to be of 'good' quality and three studies were of 'moderate' quality. One article was excluded because of a 'poor' methodological quality. Sensitivity ranges from 23%-94% and specificity ranges from 50%-74%. Inter-rater reliability was 'poor' or 'fair' in all studies. The intra-rater reliability shows a wide variance among speech language therapists.

CONCLUSION

In this systematic review, conflicting evidence is found for the validity of cervical auscultation. The reliability of cervical auscultation is insufficient when used as a stand-alone tool in the diagnosis of dysphagia in adults. There is no available evidence for the validity and reliability of cervical auscultation in children. Cervical auscultation should not be used as a stand-alone instrument to diagnose dysphagia.

摘要

目的

系统评价颈部听诊在诊断成人和儿童吞咽困难多方面问题时的可靠性和有效性的现有证据。

数据来源

医学期刊数据库(PubMed)、Embase和Cochrane图书馆数据库。

综述方法

按照系统评价和Meta分析的首选报告项目(PRISMA)声明的步骤进行系统评价。使用荷兰的“诊断准确性研究的Cochrane清单”评估纳入研究的方法学质量。

结果

通过检索策略共识别出90篇文章,应用纳入和排除标准后,本综述纳入了6篇文章。在这6项研究中,197例患者接受了颈部听诊评估。6篇文章中有2篇被认为质量“良好”,3项研究质量“中等”。1篇文章因方法学质量“差”而被排除。敏感性范围为23% - 94%,特异性范围为50% - 74%。所有研究中的评分者间信度为“差”或“一般”。言语治疗师之间的评分者内信度差异很大。

结论

在本系统评价中,发现关于颈部听诊有效性的证据相互矛盾。颈部听诊作为成人吞咽困难诊断的独立工具时可靠性不足。没有关于颈部听诊在儿童中有效性和可靠性的现有证据。颈部听诊不应作为诊断吞咽困难的独立工具使用。

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