用于识别吞咽困难和误吸风险的新型床边语音评估

Novel Bedside Phonetic Evaluation to Identify Dysphagia and Aspiration Risk.

作者信息

Festic Emir, Soto Jose Soto, Pitre Lisa A, Leveton Marilu, Ramsey Danielle M, Freeman William D, Heckman Michael G, Lee Augustine S

机构信息

Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL.

出版信息

Chest. 2016 Mar;149(3):649-59. doi: 10.1378/chest.15-0789. Epub 2016 Jan 12.

DOI:10.1378/chest.15-0789

PMID:26203916

Abstract

BACKGROUND

There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit.

METHODS

We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded three-component phonetic bedside evaluation. The recordings were scored by two blinded speech-language pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short- and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments.

RESULTS

Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P = .050) and consensus auditory-perceptual evaluation of voice (P = .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P = .001) and aspiration (AUC, 0.67; P = .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P = .001). The short- and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different.

CONCLUSIONS

Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.

摘要

背景

需要改进对有吸入风险的住院患者的临床识别。我们在重症监护病房（ICU）或中级护理病房中对广泛的有吸入风险的患者评估了我们的新型语音测试。

方法

2009年12月至2011年9月期间，我们前瞻性纳入了60例有吸入风险的住院患者，随后对其进行了音频记录的三分部语音床边评估。录音由两名不知情的言语病理学家评分。机构吞咽困难入院筛查测试由床边护士进行。主要结局，吞咽困难和吸入，通过视频荧光吞咽研究、纤维光学内镜吞咽评估或两者进行评估。我们评估了短期和长期临床结局（住院时间、随后的吸入性肺炎和呼吸衰竭、生存率）以及这些结局与语音和吞咽评估的关联。

结果

所有三个单独的语音成分与吞咽困难均存在统计学上显著的线性关联。此外，对于协调运动（P = 0.050）和嗓音的共识听觉-感知评估（P = 0.025）与吸入也存在统计学上显著的线性关联。仅协调运动就能预测吞咽困难（曲线下面积[AUC]，0.74；P = 0.001）和吸入（AUC，0.67；P = 0.012）。当与标准化吞咽困难入院筛查测试结果相结合时，其预测能力有所提高（AUC，0.79；P = 0.001）。尽管短期和长期临床结局在统计学上无差异，但语音/吞咽评分越差对其产生的不利影响越大。