Mozzanica F, Scarponi L, Pedrali S, Pizzorni N, Pinotti C, Foieni F, Zuccotti G, Schindler A
Phoniatric Unit, Department of Biomedical and Clinical Science, L. Sacco Hospital University of Milan, Milan, Italy.
Department of Rehabilitation Medicine, Casa di Cura Privata del Policlinico, Milan, Italy.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):25-31. doi: 10.14639/0392-100X-1057.
The large majority of the available dysphagia screening tools has been developed for the stroke population. Only few screening tools are suitable for heterogeneous groups of patients admitted to a subacute care unit. The Royal Brisbane and Women's Hospital (RBWH) dysphagia screening tool is a nurse-administered, evidence-based swallow screening tool for generic acute hospital use that demonstrates excellent sensitivity and specificity. No Italian version of this tool is available to date. The aim of this study was to determine the reliability and screening accuracy of the Italian version of the RBWH (I-RBWH) dysphagia screening tool. A total of 105 patients consecutively admitted to a subacute care unit were enrolled. Using the I-RBWH tool, each patient was evaluated twice by trained nurses and once by a speech and language pathologist (SLP) blind to nurses' scores. The SLP also performed standardised clinical assessment of swallowing using the Mann assessment of swallowing ability (MASA). During the first and the second administration of the I-RBWH by nurses, 28 and 27 patients, respectively, were considered at risk of dysphagia, and 27 were considered at risk after SLP assessment. Intra- and inter-rater reliability was satisfactory. Comparison between nurse I-RBWH scores and MASA examination demonstrated a sensitivity and specificity of the I-RBWH dysphagia screening tool up to 93% and 96%, respectively; the positive and negative predictive values were 90% and 97%, respectively. Thus, the current findings support the reliability and accuracy of the I-RBWH tool for dysphagia screening of patients in subacute settings. Its application in clinical practice is recommended.
大多数现有的吞咽困难筛查工具是针对中风患者群体开发的。只有少数筛查工具适用于入住亚急性护理病房的异质性患者群体。皇家布里斯班妇女医院（RBWH）吞咽困难筛查工具是一种由护士操作的、基于证据的吞咽筛查工具，适用于一般急性医院，具有出色的敏感性和特异性。迄今为止，尚无该工具的意大利语版本。本研究的目的是确定RBWH（I-RBWH）吞咽困难筛查工具意大利语版本的可靠性和筛查准确性。总共连续纳入了105名入住亚急性护理病房的患者。使用I-RBWH工具，每位患者由经过培训的护士评估两次，由一名对护士评分不知情的言语和语言病理学家（SLP）评估一次。SLP还使用吞咽能力曼恩评估法（MASA）对吞咽进行标准化临床评估。在护士首次和第二次使用I-RBWH进行评估时，分别有28名和27名患者被认为有吞咽困难风险，SLP评估后有27名患者被认为有风险。评分者内和评分者间的可靠性令人满意。护士I-RBWH评分与MASA检查之间的比较表明，I-RBWH吞咽困难筛查工具的敏感性和特异性分别高达93%和96%；阳性和阴性预测值分别为90%和97%。因此，目前的研究结果支持I-RBWH工具在亚急性环境中对患者进行吞咽困难筛查的可靠性和准确性。建议在临床实践中应用该工具。
