Jiang Youli, Chi Yue, Pan Rongjia, Zhang Dongqi, Huang Suzhen, Ju Hao, Li Yanfeng
Department of Neurology, People's Hospital of Longhua, Shenzhen, China.
Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Front Neurol. 2024 Aug 6;15:1380287. doi: 10.3389/fneur.2024.1380287. eCollection 2024.
The increasing incidence of stroke globally has led to dysphagia becoming one of the most common complications in stroke patients, with significant impacts on patient outcomes. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life.
Included studies involved stroke-diagnosed patients assessed for dysphagia using bedside screening tools. Data was sourced from Embase, PubMed, Web of Science, Scopus, and CINAHL, including publications up to 10 December 2023. The study employed both fixed-effect and random-effects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. The random-effects model was particularly utilized due to observed heterogeneity in study data.
From 6,979 records, 21 studies met the inclusion criteria, involving 3,314 participants from 10 countries. The analysis included six assessment tools: GUSS, MASA, V-VST, BSST, WST, and DNTA, compared against gold-standard methods VFSS and FEES. GUSS, MASA, and V-VST showed the highest reliability, with sensitivity and specificity rates of 92% and 85% for GUSS, 89% and 83% for MASA, respectively. Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings.
Our network meta-analysis underscores the effectiveness of GUSS, MASA, and V-VST in dysphagia screening for stroke patients, with high sensitivity and specificity making them suitable for diverse clinical settings. BSST and WST, with lower diagnostic accuracy, require more selective use. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications.
全球范围内中风发病率不断上升，导致吞咽困难成为中风患者最常见的并发症之一，对患者的预后产生重大影响。准确的吞咽困难早期筛查对于避免并发症和提高患者生活质量至关重要。
纳入的研究涉及使用床边筛查工具评估吞咽困难的中风诊断患者。数据来源于Embase、PubMed、科学网、Scopus和CINAHL，包括截至2023年12月10日的出版物。该研究采用固定效应模型和随机效应模型分析敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），每个指标均有95%的置信区间。由于研究数据中观察到异质性，特别采用了随机效应模型。
从6979条记录中，21项研究符合纳入标准，涉及来自10个国家的3314名参与者。分析包括六种评估工具：GUSS、MASA、V-VST、BSST、WST和DNTA，与金标准方法VFSS和FEES进行比较。GUSS、MASA和V-VST显示出最高的可靠性，GUSS的敏感性和特异性率分别为92%和85%，MASA分别为89%和83%。研究间的异质性最小，发表偏倚较低，增强了研究结果的可信度。
我们的网络荟萃分析强调了GUSS、MASA和V-VST在中风患者吞咽困难筛查中的有效性，其高敏感性和特异性使其适用于各种临床环境。诊断准确性较低的BSST和WST需要更有选择性地使用。未来的研究应整合患者特定的结果并规范方法，以改进吞咽困难筛查工具，最终改善患者护理并减少并发症。
