背景:由于如今患者往往有多种疾病和复杂的病史,我们的目标是识别高质量的,非工具性吞咽困难筛查工具用于在急性护理环境中检测所有疾病类别的成人吞咽困难病例。
方法:从每个数据库最早成立到2021年7月31日,在五个数据库中进行了文献检索,并以五个关键词为指导:“吞咽困难”,\'吞咽\',\'筛选\',\'test\'和\'measure\'。在不限制搜索任何特定疾病类别的情况下,审核员对原始研究进行了评估,并确定了工具是否经过了仪器评估的验证,以及是否将其设计为通过-失败程序来筛查吞咽困难是否不存在或存在.我们进一步排除了任何工具,如果它是(1)用于儿科焦点,或(2)患者自我报告问卷。使用经修订的诊断准确性研究质量评估工具(QUADAS-2)对所有最终候选工具进行了方法学质量评估。
结果:在195项研究中,确定了165种工具,20名候选工具接受了QUADAS-2审查。我们发现了六个高质量的,在急性护理环境中检测成人吞咽困难病例的非工具筛查工具,包括耶鲁燕子协议,狼吞虎咽的屏幕,多伦多床边吞咽筛查测试(英语和葡萄牙语版本),Sapienza全球床边评估吞咽和两步加厚水测试。这些高质量的工具主要是为中风患者开发的。最初只有耶鲁燕子方案对中风的异质人群进行了测试,多发性硬化症,创伤性脑损伤,食道手术,神经外科和头颈癌.
结论:结果突出表明,在包括老年住院患者在内的几个出现的高危人群中,缺乏高质量吞咽困难筛查工具的差距,或气管内拔管后的患者。需要进一步的研究来确定这六种工具是否可以有效地应用于急性护理环境中的不同高危人群,以筛选病例发现。
BACKGROUND: As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high-quality, non-instrumental
dysphagia screening tools used for the detection of adult
dysphagia cases in all disease categories in acute-care settings.
METHODS: A literature search was conducted in five databases from each database\'s earliest inception to 31 July 2021 and guided by five keywords: \'
dysphagia\', \'deglutition\', \'screening\', \'test\' and \'measure\'. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass-fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self-report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
RESULTS: Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS-2 review. We found six high-quality, non-instrumental screening tools for detecting adult
dysphagia cases in acute-care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two-Step Thickened Water Test. These high-quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head-and-neck cancer.
CONCLUSIONS: The results highlight the gap in the unavailability of high-quality
dysphagia screening tool in several emerged high-risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high-risk populations in acute-care settings to screen for cases finding.