Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan.
Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Eur Arch Otorhinolaryngol. 2023 Oct;280(10):4561-4567. doi: 10.1007/s00405-023-08101-x. Epub 2023 Jul 10.
Post-stroke dysphagia (PSD) is the most common type of dysphagia. Stroke patients with sustained dysphagia have poorer outcomes. The severity of PSD is assessed using miscellaneous scales with unknown consistencies. We aim to investigate the consistencies among miscellaneous scales, which could aid in the assessment of PSD.
A total of 49 PSD patients were enrolled. Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), Ohkuma Questionnaire, Eating Assessment Tool-10, and Repetitive Saliva Swallowing Test were performed. FOIS was performed by physicians, and DSS was conducted by both the physicians and nurses; the physicians used either videofluoroscopy (VF) or videoendoscopy (VE) for evaluation; while, the nurses assessed PSD by observation and subjective judgment.
When using VF (VF-DSS and VF-FOIS) as the gold standard for the evaluation, VE-FOIS (κ = 0.625, 95% CI 0.300-0.950, p < 0.001) has a substantial agreement with VF-FOIS, and VE-DSS (κ = 0.381, 95% CI 0.127-0.636, p = 0.007) has a fair agreement with VF-DSS. The weighted kappa of FOIS to DSS in VE (weighted κ = 0.577, 95% CI 0.414-0.740, p < 0.001) is not lower than that in VF (weighted kappa = 0.249, 95% CI 0.136-0.362, p < 0.001).
For both DSS and FOIS, only VE has a statistically significant agreement with VF. Though VF has been viewed as the traditional gold standard of dysphagia screening, it has the limitations of being invasive and equipment dependent. For PSD, VE could be considered as a substitution when VF is not available or suitable.
卒中后吞咽障碍（PSD）是最常见的吞咽障碍类型。持续性吞咽困难的卒中患者预后较差。PSD 的严重程度通过各种一致性未知的量表进行评估。我们旨在研究各种量表之间的一致性，这有助于 PSD 的评估。
共纳入 49 例 PSD 患者。进行了功能性口腔摄入量表（FOIS）、吞咽障碍严重程度量表（DSS）、大塚问卷、饮食评估工具-10 和重复唾液吞咽测试。FOIS 由医生进行，DSS 由医生和护士共同进行；医生使用透视吞咽造影（VF）或视频内镜（VE）进行评估；而护士则通过观察和主观判断来评估 PSD。
当使用 VF（VF-DSS 和 VF-FOIS）作为评估的金标准时，VE-FOIS（κ=0.625，95%CI 0.300-0.950，p<0.001）与 VF-FOIS 具有显著一致性，而 VE-DSS（κ=0.381，95%CI 0.127-0.636，p=0.007）与 VF-DSS 具有适度一致性。VE 中 FOIS 与 DSS 的加权κ值（加权κ=0.577，95%CI 0.414-0.740，p<0.001）并不低于 VF 中的加权κ值（加权κ=0.249，95%CI 0.136-0.362，p<0.001）。
对于 DSS 和 FOIS，只有 VE 与 VF 具有统计学显著一致性。虽然 VF 一直被视为吞咽障碍筛查的传统金标准，但它具有侵入性和设备依赖性的局限性。对于 PSD，当 VF 不可用或不适用时，可以考虑 VE 作为替代。
