Regan Julie, Lawson Susan, De Aguiar Vânia
Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin 2, Ireland.
Speech and Language Therapy Department, Tallaght Hospital, Dublin 24, Ireland.
Dysphagia. 2017 Oct;32(5):714-720. doi: 10.1007/s00455-017-9822-2. Epub 2017 Jul 13.
Adults with COPD frequently present with dysphagia, which often leads to clinical complications and hospital admissions. This study investigates the ability of the Eating Assessment Tool (EAT-10) to predict aspiration during objective dysphagia evaluation in adults with stable COPD. Thirty adults (20 male, 10 female; mean age = 69.07 ± 16.82) with stable COPD attended an outpatient dysphagia clinic for a fiberoptic endoscopic evaluation of swallowing (FEES) in an acute teaching hospital (January 2015-November 2016). During evaluations, individuals completed an EAT-10 rating scale followed immediately by a standardised FEES exam. Aspiration status during FEES was rated using the penetration-aspiration scale by clinicians blinded to EAT-10 scores. Data were retrospectively analysed. Significant differences in mean EAT-10 scores were found between aspirators (16.3; SEM = 2.165) and non-aspirators (7.3; SEM = 1.009) (p = 0.000). The EAT-10 predicted aspiration with a high level of accuracy (AUC = 0.88). An EAT-10 cut-off value of >9 presented a sensitivity of 91.67, specificity of 77.78 with positive and negative likelihood ratios of 4.12 and 0.11, respectively. Positive and negative predictive values were 73.30 and 93.30, respectively. Diagnostic odds ratio was 38.50 (p < 0.01, CI 3.75-395.42). EAT-10 is a quick, easy to administer tool, which can accurately predict the presence of aspiration in adults with COPD. The scale can also very accurately exclude the absence of aspiration, helping clinicians to determine the need for onward referral for a comprehensive dysphagia evaluation. This may ultimately reduce clinical complications and hospital admissions resulting from dysphagia in this clinical population.
慢性阻塞性肺疾病（COPD）成人患者常伴有吞咽困难，这往往会导致临床并发症及住院治疗。本研究旨在调查饮食评估工具（EAT - 10）在稳定期COPD成人患者客观吞咽困难评估中预测误吸的能力。30例稳定期COPD成人患者（20例男性，10例女性；平均年龄 = 69.07 ± 16.82）在一家急症教学医院的门诊吞咽困难诊所接受了纤维内镜吞咽功能检查（FEES）（2015年1月至2016年11月）。在评估过程中，患者先完成EAT - 10评分量表，随后立即进行标准化的FEES检查。FEES检查期间的误吸状态由对EAT - 10评分不知情的临床医生使用渗透 - 误吸量表进行评定。对数据进行回顾性分析。发现误吸者（16.3；标准误 = 2.165）和无误吸者（7.3；标准误 = 1.009）的EAT - 10平均得分存在显著差异（p = 0.000）。EAT - 10预测误吸的准确性较高（曲线下面积 = 0.88）。EAT - 10临界值>9时，灵敏度为91.67，特异度为77.78，阳性似然比和阴性似然比分别为4.12和0.11。阳性预测值和阴性预测值分别为73.30和93.30。诊断比值比为38.50（p < 0.01，可信区间3.75 - 395.42）。EAT - 10是一种快速、易于实施的工具，能够准确预测COPD成人患者是否存在误吸。该量表还能非常准确地排除无误吸情况，帮助临床医生确定是否需要进一步转诊进行全面的吞咽困难评估。这最终可能减少该临床人群因吞咽困难导致的临床并发症及住院治疗。
