Screening Accuracy for Aspiration Using Bedside Water Swallow Tests A Systematic Review and Meta-Analysis
Screening Accuracy for Aspiration Using Bedside Water Swallow Tests A Systematic Review and Meta-Analysis
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DOI：
10.1016/j.chest.2016.03.059
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发表时间：
2016-07-01
期刊：
影响因子：
9.6
通讯作者：
Schooling, Tracy
中科院分区：
文献类型：
--
作者：
Brodsky, Martin B.;Suiter, Debra M.;Schooling, Tracy
背景：老年人因吸入性肺炎住院的人数增加了一倍。使用床边水吞咽试验（WST）筛查吞咽相关误吸可以有效且具有成本效益地预防其他合并症和死亡率。我们评估了床旁WST筛查的准确性，用于识别患者吞咽困难相关的aspiration.METHODS的风险：16个在线数据库，谷歌学术，并通过2015年5月已知的内容专家进行了检索。仅纳入了年龄≥ 18岁的患者的前瞻性研究，这些患者接受了经鼻内窥镜检查或视频透视检查验证的WST筛查。数据提取采用双盲提取和质量评估后的荟萃分析观察性研究在流行病学guidelines.RESULTS：气道反应（例如，咳嗽/窒息）或没有声音的变化（例如，湿/gurgly的声音质量）被用来确定在三个不同的床边WST吸入。单次啜饮容量（1-5 mL）的合并估计值为71%敏感性（95% CI，63%-78%）和90%特异性（95% CI，86%-93%）。90至100 mL试验的连续性啜吸的敏感性为91%（95% CI，89%-93%），特异性为53%（95% CI，51%-55%）。逐步增加水量的试验敏感性为86%（95% CI，76%-93%），特异性为65%（95% CI，57%-73%）。气道反应与语音变化提高了整体准确性，在确定aspiration.CONCLUSIONS：目前使用的床边WST提供足够的，虽然不理想，实用程序在筛选吸入。在没有明显气道反应或声音变化的患者中，大容量连续啜吸可适当排除误吸风险。当存在临床体征时，适当控制小容量单次抽吸。结合这些床边方法可能会提高筛查的准确性，但需要进一步的研究。
BACKGROUND: Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration.METHODS: Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients >= 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines.RESULTS: Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration.CONCLUSIONS: Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.