《进食评估工具-10 鉴别吞咽安全性和效率损伤的能力》
Discriminant Ability of the Eating Assessment Tool-10 to Detect Swallowing Safety and Efficiency Impairments.
机构信息
Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.
Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A.
出版信息
Laryngoscope. 2022 Dec;132(12):2319-2326. doi: 10.1002/lary.30043. Epub 2022 Feb 9.
OBJECTIVES/HYPOTHESIS: Quick, sensitive dysphagia screening tools are necessary to identify high-risk patients for further evaluation in busy multidisciplinary amyotrophic lateral sclerosis (ALS) clinics. We examined the relationship between self-perceived dysphagia using the validated Eating Assessment Tool-10 (EAT-10) and videofluoroscopic analysis of swallowing safety and efficiency.
STUDY DESIGN
Prospective, observational, longitudinal study.
METHODS
Individuals with ALS completed the EAT-10 and a videofluoroscopic swallowing study. Duplicate, independent, blinded analyses of the validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale were performed to index swallowing safety and efficiency (mild dysphagia: DIGEST ≥ 1, moderate dysphagia: DIGEST ≥ 2). A between-groups analysis of variance with Games-Howell test for post-hoc pairwise comparisons was performed to examine EAT-10 scores across dysphagia severity levels. Receiver operator characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, positive-negative predictive values (PPV, NPV), and odds ratios (OR) were derived.
RESULTS
Four hundred and thirty five paired EAT-10 and DIGEST scores were analyzed. Mean EAT-10 score was 8.48 (95% confidence interval [CI]: 7.63-9.33). Individuals with dysphagia demonstrated higher EAT-10 scores (mild: 4.1 vs. 11.3, moderate: 6.0 vs. 17.5, P < .001). Mean EAT-10 scores increased across DIGEST levels (D0: 4.1, D1: 7.9, D2: 15.1, D3: 20.4, D4: 39.0). For mild dysphagia, an EAT-10 cut score of 3 was optimal: AUC 0.74 (95% CI: 0.69-0.78; sensitivity: 77%; specificity: 53%; PPV: 71%; NPV: 60%; OR: 3.5). An EAT-10 cut score of 7 optimized detection of moderate dysphagia: AUC 0.83 (95% CI: 0.78-0.87; sensitivity: 81%; specificity: 66%; PPV: 39%; NPV: 93%; OR: 8.1).
CONCLUSION
The EAT-10 is an easy-to-administer dysphagia screening tool with good discriminant ability for use in ALS clinics.
LEVEL OF EVIDENCE
2 Laryngoscope, 132:2319-2326, 2022.
目的/假设：快速、敏感的吞咽障碍筛查工具对于在繁忙的多学科肌萎缩侧索硬化（ALS）诊所中识别高危患者进行进一步评估是必要的。我们研究了使用经过验证的饮食评估工具-10（EAT-10）评估的自我感知吞咽障碍与吞咽安全性和效率的视频荧光检查之间的关系。
研究设计
前瞻性、观察性、纵向研究。
方法
ALS 患者完成 EAT-10 和视频荧光吞咽研究。对经过验证的动态成像吞咽毒性分级（DIGEST）量表进行重复、独立、盲法分析，以评估吞咽安全性和效率（轻度吞咽困难：DIGEST≥1，中度吞咽困难：DIGEST≥2）。使用方差分析进行组间分析，并进行 Games-Howell 检验进行事后两两比较，以检查 EAT-10 评分在不同吞咽困难严重程度水平上的差异。得出受试者工作特征曲线分析、曲线下面积（AUC）、灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）和优势比（OR）。
结果
分析了 435 对 EAT-10 和 DIGEST 评分。平均 EAT-10 评分为 8.48（95%置信区间[CI]：7.63-9.33）。有吞咽困难的患者 EAT-10 评分较高（轻度：4.1 分 vs. 11.3 分，中度：6.0 分 vs. 17.5 分，P<.001）。EAT-10 评分随着 DIGEST 水平的升高而升高（D0：4.1，D1：7.9，D2：15.1，D3：20.4，D4：39.0）。对于轻度吞咽困难，EAT-10 评分 3 分为最佳截断值：AUC 0.74（95%CI：0.69-0.78；灵敏度：77%；特异性：53%；PPV：71%；NPV：60%；OR：3.5）。EAT-10 评分 7 分可优化中度吞咽困难的检出：AUC 0.83（95%CI：0.78-0.87；灵敏度：81%；特异性：66%；PPV：39%；NPV：93%；OR：8.1）。
结论
EAT-10 是一种易于管理的吞咽障碍筛查工具，在 ALS 诊所中具有良好的鉴别能力。
证据水平
2 级喉镜，132：2319-2326，2022。
Zotero 插件