Jiang Jiin-Ling, Fu Shu-Ying, Wang Wan-Hsiang, Ma Yu-Chin
Department of Nursing, Tzu Chi University, Hualien, Taiwan.
Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Tzu Chi Med J. 2016 Apr-Jun;28(2):41-48. doi: 10.1016/j.tcmj.2016.04.006. Epub 2016 Jun 21.
Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.
神经功能损害后出现的吞咽困难会增加脱水、营养不良、吸入性肺炎甚至死亡的风险。据报道，吞咽困难筛查可改变不良结局。本综述评估了用于筛查神经疾病患者吞咽困难的测量工具的有效性和可靠性，以确定一种护士可使用的可行工具。检索了电子数据库中1992年至2015年与吞咽困难筛查测量相关的研究。检索范围涵盖了PubMed、CINAHL、Cochrane、Medline、EBSCO主机以及CEPS + CETD数据库。使用清单来评估心理测量质量。评估了这些工具在医院被护士纳入常规护理的可行性。共检索到104篇论文，最终有8篇文章符合纳入标准。筛查工具的敏感性范围为29%至100%，特异性范围为65%至100%。评分者间信度范围为良好到极佳的一致性。基于质量评估，所有纳入研究由于方法学特征不足均存在偏倚风险。标准化吞咽评估是检测吞咽困难最合适的工具，因为其心理测量特性和可行性高于其他护士可实施的筛查工具。
