Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis.
Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis.
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DOI：
10.1111/nmo.12700
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发表时间：
2016-01
影响因子：
3.5
通讯作者：
Gooch C
中科院分区：
文献类型：
--
作者：
Plowman EK;Tabor LC;Robison R;Gaziano J;Dion C;Watts SA;Vu T;Gooch C
口咽吞咽困难在肌萎缩侧索硬化症（ALS）患者中很常见，可导致营养不良、吸入性肺炎和死亡。这些因素需要早期发现高危患者，以延长安全口服摄入和肺功能的维持。本研究旨在评估进食评估工具（EAT-10）识别ALS患者吞咽期间不安全气道保护的判别能力。70名ALS患者完成了EAT-10调查，并接受了标准化的吞咽视频荧光镜评估（VFES）。两名盲法评定者使用穿透抽吸量表（PAS）确定气道安全性。进行组间ANOVA（安全vs.穿透器vs.抽吸器），并计算灵敏度、特异性、曲线下面积（AUC）和似然比。安全吞咽器、穿透器和吸引器（SEM）的平均EAT-10评分分别为：4.28（0.79）vs. 7.10（1.79）vs. 20.50（3.19），吸引器与安全吞咽器和吸引器与穿透器之间存在显著差异（p<0.001）。EAT-10表现出准确识别ALS穿透器/吸引器（PAS≥3）的良好判别能力，临界值为3（AUC：0.77，灵敏度：88%，特异性：57%）。EAT-10在识别抽吸器（PAS≥6）方面表现出极佳的准确性，使用8分的临界值（AUC：0.88，灵敏度：86%，特异性：72%，似然比：3.1，阴性预测值：95.5%）。EAT-10区分ALS患者的安全吞咽与不安全吞咽。这种患者自我报告量表可以代表一个快速和有意义的援助吞咽困难筛查在忙碌ALS诊所的识别和转诊吞咽困难的患者进行进一步的仪器评估。
Oropharyngeal dysphagia is prevalent in individuals with amyotrophic lateral sclerosis (ALS) leading to malnutrition, aspiration pneumonia and death. These factors necessitate early detection of at risk patients to prolong maintenance of safe oral intake and pulmonary function. This study aimed to evaluate the discriminant ability of the Eating Assessment Tool (EAT-10) to identify ALS patients with unsafe airway protection during swallowing. 70 ALS patients completed the EAT-10 survey and underwent a standardized videofluoroscopic evaluation of swallowing (VFES). Two blinded raters determined airway safety using the Penetration Aspiration Scale (PAS). A between groups ANOVA (safe vs. penetrators vs. aspirators) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios calculated. Mean EAT-10 scores for safe swallowers, penetrators and aspirators (SEM) were: 4.28 (0.79) vs. 7.10 (1.79) vs. 20.50 (3.19) respectively with significant differences noted for aspirators vs. safe swallowers and aspirators vs. penetrators (p<0.001). The EAT-10 demonstrated good discriminant ability to accurately identify ALS penetrator/aspirators (PAS≥3) with a cut off score of 3 (AUC:0.77, sensitivity: 88%, specificity: 57%). The EAT-10 demonstrated excellent accuracy at identifying aspirators (PAS≥6) utilizing a cut off score of 8 (AUC:0.88, sensitivity: 86%, specificity: 72%, likelihood ratio: 3.1, negative predictive value: 95.5%). The EAT-10 differentiated safe vs. unsafe swallowing in ALS patients. This patient self-report scale could represent a quick and meaningful aide to dysphagia screening in busy ALS clinics for the identification and referral of dysphagic patients for further instrumental evaluation.