Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2.
Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2.
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DOI：
10.1002/cncr.34079
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发表时间：
2022-04-01
期刊：
影响因子：
6.2
通讯作者：
Warneke CL
中科院分区：
文献类型：
--
作者：
Hutcheson KA;Barbon CEA;Alvarez CP;Warneke CL
Digest是一种经过验证的方法，可以根据标准获得的放射学改良BBS研究中的渗透/吸入和咽部残留的程度和模式，将咽部吞咽损伤的严重程度作为癌症的毒性进行分级。自2016年实施以来，临床和研究用户确定了轻微安全损害分级的细化领域。目的是评估改进的DIGEST安全分级标准(PER DIGESTv2)的性能和有效性。制定了改进的安全标准，并与临床和研究用户一起进行了审查。DIGESTv2包括对安全标准的两项更改。所有DIGESTv1盲法分级的MBS均从注册数据库中抽取(在2005年12月至2019年7月期间，有1331名患者接受了MBS)。应用新的标准来得出DIGEST安全等级版本2。标准效度的测量包括MDADI综合评分、MBSImP™和咽部总分、MBSImP™和咽喉成分(第8-11项)和PSS-HN饮食，与DIGEST安全性和v1和v2的总体消化等级相关，并在重新分配的等级之间进行成对比较。在V2安全标准的应用下，112/1,331(8.4%)和79/1,331(5.9%)的考试在DIGEST安全和总体分数上发生了变化。安全性和总体消化分级v1和v2与标准测量显著相关，包括咽部MBSImp总量、喉部MBSImp感兴趣参数、MDADI和PSS-HN(p<；0.0001)；v1和v2之间的相关性保持相似的程度。升级的46个考试(从版本1的安全等级1重新分配到版本2的等级2)与其他安全等级2(V1)的表现更相似，同样地，降级的66个考试(从版本1的安全等级1重新分配到版本2的等级0)。使用摘要方法定义轻微安全损害的细化标准在少量检查中改变了分数。DIGESTv2标准保持了标准的有效性，证明了顺序性，并在这些罕见的情况下改进了方法的性能。Digest是研究人员在2016年开发和验证的一种方法，使用决策树或流程图对咽部吞咽功能障碍(吞咽困难)的严重程度进行评级，以指导临床医生对标准的放射学改良吞钡研究进行审查。这项工作报告了更新的(版本2)摘要标准的有效性，该标准包含了对决策树的两个修改。第二版摘要(DIGESTv2)对决策树进行了两次修改，临床医生使用的决策树根据放射学改良的吞钡研究中喉部穿透/吸入的模式对轻度(1级)安全损害进行分级。这项工作的主要发现包括：1)DIGESTv2相对于临床医生分级的咽部吞咽障碍和患者报告的吞咽困难的参考测量标准的有效性，以及2)DIGESTv2的顺序性。
DIGEST is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since implementation in 2016, areas for refinement of grading mild safety impairment were identified by clinical and research users. The objective was to assess performance and validity of refined DIGESTsafety grading criteria (per DIGESTv2). Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 includes two changes to safety criteria. All MBS with blinded DIGESTv1 grading were sampled from a registry database (1,331 patients underwent MBS over the period 12/2005 to 07/2019). New criteria were applied to derive DIGESTsafety grade version 2. Measures of criterion validity, including MDADI composite score, MBSImP™© Pharyngeal Total, MBSImP™© hyolaryngeal components (items 8–11), and PSS-HN diet, were correlated with DIGESTsafety and overall DIGEST grade from v1 and v2, and compared pairwise between re-assigned grades. With application of v2 Safety criteria, 112/1,331 (8.4%) and 79/1,331 (5.9%) of exams changed in DIGESTsafety and overall grades, respectively. Safety and overall DIGEST grades v1 and v2 significantly correlated with criterion measures including MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS-HN (p<0.0001); correlations maintained similar magnitude between v1 and v2. 46 exams up-graded (re-assigned from Safety grade 1 per version 1 to grade 2 per version 2) performed more similarly to other safety grade 2 (v1), and likewise for 66 exams down-graded (re-assigned from Safety grade 1 per version 1 to grade 0 per version 2). Refined criteria defining mild safety impairment using the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved performance of the method in these rare scenarios. DIGEST is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) using a decision-tree or flowsheet to guide clinician’s review of a standard radiographic modified barium swallow study. This work reports the validity of updated (version 2) DIGEST criteria that incorporate two modifications to the decision-tree. Version 2 of DIGEST (DIGESTv2) incorporated two modifications to the decision-tree used by clinicians to grade mild (grade 1) safety impairment based on patterns of laryngeal penetration/aspiration on a radiographic modified barium swallow study. Key findings of this work include: 1) criterion validity of DIGESTv2 relative to references measures of clinician-graded pharyngeal swallowing impairment and patient-reported dysphagia, and 2) ordinality of DIGESTv2.
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DOI：
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发表时间：
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影响因子：
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