Javorszky Susanne Maria, Reiter Raphael, Iglseder Bernhard
Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.
Department of Health Sciences, University of Applied Sciences, Vienna, Austria.
JMIR Res Protoc. 2023 Aug 11;12:e46252. doi: 10.2196/46252.
Demographic changes will raise the need for specialized care of older patients. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty, and disability, swallowing disorders increase with advancing age, with prevalence rates reported to be as high as 44% in acute geriatric hospital settings and 80% in long-term care facilities. Hence, systematic screening of older patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, and malnutrition and improve quality of life. Several screening tools have been evaluated in emergency and stroke units. However, no published dysphagia screening tool has been validated in the hospitalized, older adult population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step.
The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for older inpatients against an instrumental swallowing evaluation, the flexible endoscopic evaluation of swallowing (FEES), which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed older adult population. The presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES), analyzed by the standardized penetration-aspiration scale.
To validate the GEBS, a prospective cohort study will be carried out. Two institutions, an acute geriatric department and a long-term care facility, will aim to recruit a total of 100 patients aged ≥75 years. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. The analysis of pseudonymized data sets will be done by a third investigator. Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient, and the reliability of the proposed dysphagia screening tool using the κ coefficient.
Recruitment started in October 2022 and will end in April 2024. Data publication is planned for early 2025.
If proven to be a valid screening tool for the early detection of dysphagia, further studies including different older adult populations as well as studies to determine the impact of systematic dysphagia screening on parameters, such as rates of aspiration pneumonia or nutritional status, should be planned. Effective screening of dysphagia will lead to earlier detection of patients with impaired swallowing. Those who fail the screening will be referred to speech language pathology for further diagnosis, thus optimizing care while streamlining personnel resources.
ISCRTN Registry ISRCTN11581931; https://www.isrctn.com/ISRCTN11581931.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46252.
人口结构变化将增加对老年患者专科护理的需求。口咽吞咽困难最近被宣布为一种老年综合征，反映了其多因素背景。除了多种疾病、肌肉减少症、虚弱和残疾外，吞咽障碍随着年龄的增长而增加，据报道，在老年急性医院环境中的患病率高达44%，在长期护理机构中高达80%。因此，系统筛查老年患者以诊断吞咽困难并开始治疗对于预防团块性死亡、吸入性肺炎和营养不良以及改善生活质量至关重要。几种筛查工具已在急诊科和卒中单元进行了评估。然而，尚未有已发表的吞咽困难筛查工具在住院老年人群中使用吞咽困难诊断的金标准作为参考测试进行验证。对所提议测试的验证是第一步。
老年床边吞咽筛查（GEBS）研究旨在针对仪器吞咽评估——柔性内镜吞咽评估（FEES）（被视为金标准），验证一种专门为老年住院患者开发的新筛查工具。要评估的主要结果是GEBS在混合老年人群中检测吞咽困难的敏感性和特异性。吞咽困难的存在将通过仪器吞咽评估（FEES）定义，并通过标准化的渗透 - 误吸量表进行分析。
为了验证GEBS，将进行一项前瞻性队列研究。两个机构，一个老年急性科和一个长期护理机构，计划共招募100名年龄≥75岁的患者。在获得知情同意后，患者将接受GEBS中描述的全面筛查方案以及使用FEES进行的吞咽功能评估。研究人员将对各自其他测试的结果不知情。由第三位研究人员对匿名数据集进行分析。要考虑的结果包括敏感性、特异性、诊断比值比、阳性和阴性似然比，以及使用κ系数评估所提议的吞咽困难筛查工具的可靠性。
招募于2022年10月开始，将于2024年4月结束。计划于2025年初发表数据。
如果被证明是一种用于早期检测吞咽困难的有效筛查工具，应计划开展进一步研究，包括纳入不同的老年人群，以及确定系统性吞咽困难筛查对诸如吸入性肺炎发生率或营养状况等参数影响的研究。有效筛查吞咽困难将导致更早发现吞咽功能受损的患者。筛查未通过的患者将被转诊至言语病理学进行进一步诊断，从而在优化护理的同时精简人力资源。
ISCRTN注册库ISRCTN11581931；https://www.isrctn.com/ISRCTN11581931。
国际注册报告识别码（IRRID）：DERR1 - 10.2196/46252。
