Jørgensen Lise Walther, Søndergaard Kasper, Melgaard Dorte, Warming Susan
Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Dept. of Physical and Occupational Therapy, Bld. 10, Bispebjerg Bakke 23, DK2400 Copenhagen NV, Denmark.
Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark.
Clin Nutr ESPEN. 2017 Dec;22:85-91. doi: 10.1016/j.clnesp.2017.08.003. Epub 2017 Aug 31.
Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential in order to detect patients in need of further assessment. The Volume-Viscosity Swallow Test (V-VST) has been shown to be a valid screening test for OD in mixed outpatient populations. However, as reliability of the test has yet to be investigated in a population of medical and geriatric patients admitted due to acute illness, we aimed to determine the interrater reliability of the V-VST in this clinical setting. Reporting in this study is in accordance with proposed guidelines for the reporting of reliability and agreement studies (GRRAS).
In three Danish hospitals (CRD-BFH, CRD-GH, NDR-H) 11 skilled occupational therapists examined an unselected group of 110 patients admitted to geriatric or medical wards. In an overall agreement phase raters reached ≥80% agreement before data collection phase was commenced. The V-VST was applied to patients twice within maximum one hour by raters who administrated the test in an order based on randomization, blinded to each other's results. Agreement, Kappa values, weighed Kappa values and Kappa adjusted for bias and prevalence are reported.
The interrater reliability of V-VST as screening test for OD in patients admitted to geriatric or medical wards was substantial with an overall Kappa value of 0.77 (95% CI 0.65-0.89) however interrater reliability varied among hospitals ranging from 0.37 (95% CI -0.01 to 0.41) to 0.85 (95% CI 0.75-1.00). Interrater reliability of the accompanying recommendations of volume and viscosity was moderate with a weighted kappa value of 0.55 (95% CI 0.37-0.73) for viscosity and 0.53 (95% CI 0.36-0.7) for volume. The overall prevalence of OD was 34.5%, ranging from 8% to 53.6% across hospitals. The prevalence and bias adjusted Kappa value (PABAK) was 0.76 (range 0.6-0.85). Mean time to perform the test was 13.1 min (SD 6.924).
The V-VST seems to be a moderately reliable screening tool for detecting OD among medical and geriatric patients. However, the recommendations of volume and viscosity add limited clinical value to the test.
口咽吞咽困难（OD）在因急性疾病入院的内科和老年患者中很常见，它与营养不良、住院时间延长和死亡率增加有关。对于有OD风险的患者，一种有效且可靠的床边筛查测试对于检测需要进一步评估的患者至关重要。容量 - 粘度吞咽测试（V - VST）已被证明是混合门诊人群中OD的有效筛查测试。然而，由于该测试在因急性疾病入院的内科和老年患者群体中的可靠性尚未得到研究，我们旨在确定在这种临床环境中V - VST的评分者间可靠性。本研究的报告符合可靠性和一致性研究报告的拟议指南（GRRAS）。
在丹麦的三家医院（CRD - BFH、CRD - GH、NDR - H），11名熟练的职业治疗师对110名入住老年病房或内科病房的未选定患者进行了检查。在总体一致性阶段，评分者在数据收集阶段开始前达成了≥80%的一致性。V - VST由评分者在最多一小时内对患者进行两次应用，评分者根据随机化顺序进行测试，对彼此的结果不知情。报告了一致性、卡帕值、加权卡帕值以及针对偏差和患病率调整后的卡帕值。
V - VST作为老年病房或内科病房患者OD筛查测试的评分者间可靠性较高，总体卡帕值为0.77（95%CI 0.65 - 0.89），然而各医院之间的评分者间可靠性有所不同，范围从0.37（95%CI - 0.01至0.41）到0.85（95%CI 0.75 - 1.00）。伴随的容量和粘度建议的评分者间可靠性中等，粘度的加权卡帕值为0.55（95%CI 0.37 - 0.73），容量的加权卡帕值为0.53（95%CI 0.36 - 0.7）。OD的总体患病率为34.5%，各医院范围从8%到53.6%。患病率和偏差调整后的卡帕值（PABAK）为0.76（范围0.6 - 0.85）。进行测试的平均时间为13.1分钟（标准差6.924）。
V - VST似乎是检测内科和老年患者中OD的一种中等可靠的筛查工具。然而，容量和粘度的建议对该测试的临床价值有限。
