Clinical utility of the 3-ounce water swallow test
Clinical utility of the 3-ounce water swallow test
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DOI：
10.1007/s00455-007-9127-y
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发表时间：
2008-09-01
期刊：
影响因子：
2.6
通讯作者：
Leder, Steven B.
中科院分区：
文献类型：
--
作者：
Suiter, Debra M.;Leder, Steven B.
3盎司的吞水测试经常用于筛查个人的误吸风险。然而，先前关于其临床用途的研究由于样本量小和方法不同而受到统计能力不足的困扰。重要的是，研究仅限于少数选定的患者群体，从而限制了3盎司测试的广泛推广和适用性。本研究的目的是研究3盎司水吞试验在确定大量异质患者吸入状态和口服喂养建议方面的临床应用。光纤内窥镜吞咽评估（FEES）与3盎司水吞咽测试一起对3000名年龄和诊断范围广泛的参与者进行。总共有1151只（38.4%）通过了3盎司的吞水测试，1849只（61.6%）没有通过。3盎司吞水试验预测FEES期间吸入状态的敏感性为96.5%，特异性为48.7%，假阳性率为51.3%。根据FEES结果确定口服摄入安全个体的敏感性为96.4%，特异性为46.4%，假阳性率为53.6%。通过吞咽3盎司水的测试似乎可以很好地预测对稀液体的耐受能力。然而，检测失败并不意味着不能耐受稀液，即特异性低、假阳性率高。仅使用3盎司吞水试验来决定液体摄入的安全性，导致近50%的受测患者过度转诊和不必要的液体摄入限制。此外，因为71%没有通过3盎司水吞咽测试的参与者被认为是安全的口服饮食，所以没有通过3盎司水吞咽测试并不意味着吞咽失败。3盎司水吞试验的临床用途已经扩展到包括广泛的医疗和外科诊断类别。重要的是，这是第一次表明，如果通过了3盎司水的吞咽测试，就可以提出饮食建议，而无需进一步客观的吞咽困难测试。
The 3-ounce water swallow test is frequently used to screen individuals for aspiration risk. Prior research concerning its clinical usefulness, however, is confounded by inadequate statistical power due to small sample sizes and varying methodologies. Importantly, research has been limited to a few select patient populations, thereby limiting the widespread generalizability and applicability of the 3-ounce test. The purpose of this study was to investigate the clinical utility of the 3-ounce water swallow test for determining aspiration status and oral feeding recommendations in a large and heterogeneous patient population. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed in conjunction with the 3-ounce water swallow test on 3000 participants with a wide range of ages and diagnoses. A total of 1151 (38.4%) passed and 1849 (61.6%) failed the 3-ounce water swallow test. Sensitivity of the 3-ounce water swallow test for predicting aspiration status during FEES = 96.5%, specificity = 48.7%, and false positive rate = 51.3%. Sensitivity for identifying individuals who were deemed safe for oral intake based on FEES results = 96.4%, specificity = 46.4%, and false positive rate = 53.6%. Passing the 3-ounce water swallow test appears to be a good predictor of ability to tolerate thin liquids. However, failure often does not indicate inability to tolerate thin liquids, i.e., low specificity and high false-positive rate. Use of the 3-ounce water swallow test alone to make decisions regarding safety of liquid intake results in over-referral and unnecessary restriction of liquid intake for nearly 50% of patients tested. In addition, because 71% of participants who failed the 3-ounce water swallow test were deemed safe for an oral diet, nonsuccess on the 3-ounce water swallow test is not indicative of swallowing failure. The clinical utility of the 3-ounce water swallow test has been extended to include a wide range of medical and surgical diagnostic categories. Importantly, for the first time it has been shown that if the 3-ounce water swallow test is passed, diet recommendations can be made without further objective dysphagia testing.