Hawkins Daniel, Cabrera Claudia I, Kominsky Rachel, Nahra Alexis, Howard N Scott, Maronian Nicole
Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Department of Speech-Language Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Laryngoscope. 2021 Dec;131(12):2666-2670. doi: 10.1002/lary.29377. Epub 2021 Jan 27.
OBJECTIVES/HYPOTHESIS: Dysphagia is associated with increased mortality and healthcare costs. The modified barium swallow study (MBS) is the gold standard in assessing oropharyngeal dysphagia, but does not evaluate the esophagus. A barium esophagram can visualize the esophagus but does not evaluate the oropharyngeal swallow, nor does it utilize the expertise of speech and language pathologists. Providers may order one or both studies yet still risk missing critical pathology.
Retrospective cohort study.
A retrospective chart review was conducted at an academic medical center between January 2016 and June 2019 focused on patients who had both MBS and esophagram as imaging for dysphagia evaluation. Analysis determined whether MBS and esophagram performed concomitantly improved diagnostic clarity.
A total of 5,183 patients underwent 6,066 swallow studies for dysphagia in the study period. Of which, 124 of these patients had concurrent MBS and esophagram. 10.5% of concurrent studies demonstrated a congruent negative evaluation. 59.7% of patients had an unremarkable MBS or esophagram paired with abnormal findings within the corresponding esophagram or MBS, respectively. 29.8% had both MBS and esophagrams that demonstrated an abnormality, but with unique pathologies identified by each study. In total, 85.1% of unremarkable MBS or esophagrams were paired with abnormal findings in the corresponding esophagram or MBS, respectively.
Selection of diagnostic testing is variable among providers and may be influenced by healthcare systems. This analysis revealed that MBS and esophagrams provide unique diagnoses. Concurrent MBS and esophagrams may improve diagnostic accuracy, yet minimize additional studies. National practices around dysphagia diagnostics are inconsistent and would benefit from standardization.
4 Laryngoscope, 131:2666-2670, 2021.
目的/假设：吞咽困难与死亡率增加和医疗成本上升相关。改良钡餐吞咽造影检查（MBS）是评估口咽吞咽困难的金标准，但不评估食管。食管钡餐造影可显示食管情况，但不评估口咽吞咽，也未利用言语和语言病理学家的专业知识。医疗服务提供者可能会同时开具这两项检查中的一项或两项，但仍有遗漏关键病变的风险。
回顾性队列研究。
在2016年1月至2019年6月期间，于一家学术医疗中心进行了一项回顾性病历审查，重点关注那些同时进行了MBS和食管造影以评估吞咽困难的患者。分析确定同时进行MBS和食管造影是否能提高诊断清晰度。
在研究期间，共有5183例患者因吞咽困难接受了6066次吞咽检查。其中，124例患者同时进行了MBS和食管造影。10.5%的同时检查显示一致的阴性评估结果。59.7%的患者MBS或食管造影正常，但分别在相应的食管造影或MBS中发现了异常结果。29.8%的患者MBS和食管造影均显示异常，但每项检查发现了独特的病变。总体而言，85.1%的正常MBS或食管造影分别与相应的食管造影或MBS中的异常结果相关。
医疗服务提供者在诊断检查的选择上存在差异，可能受到医疗系统的影响。该分析表明，MBS和食管造影提供了独特的诊断结果。同时进行MBS和食管造影可能提高诊断准确性，同时减少额外检查。目前全国范围内吞咽困难诊断的做法不一致，标准化将使其受益。
4《喉镜》，131:2666 - 2670，2021年。
