柔性内镜吞咽评估（FEES）的实践差异：一项国际调查。

文献信息

中文摘要

背景： 柔性内镜吞咽评估（FEES）是仪器化吞咽困难评估的基石，然而在不同临床环境中已记录到显著的实践差异。本研究旨在描述FEES方案的差异，并探讨临床医生和专业特征、实践模式与解读临床发现的信心之间的关联。方法：109名具有FEES经验的专业人员完成了一项在线调查。最终分析样本包括97名参与者。调查评估了人口学和专业背景、方案组成部分、检查时长以及对临床判断的自我评定信心。结果：在FEES方案组成部分中发现了显著的异质性，包括感觉测试纳入不一致、染料使用可变以及评分量表采用多样。98.9%的受访者使用了渗透-误吸量表，而其他量表的采用率较低。判断误吸存在的信心最高，判断误吸深度的信心最低。更多的FEES特定经验与更短的检查时长相关（p=0.03），但经验年数或教育水平均不能显著预测判断的总体信心。医生身份和更高教育水平与进行正式感觉测试显著相关。结论：FEES在临床实践中的实施存在相当大的变异性。判断信心似乎受临床发现的复杂性和结构化评分工具的可用性影响，而不仅仅受经验或教育影响。这些发现支持需要更清晰地定义核心方案组成部分、开发针对复杂吞咽参数的标准化工具有以及系统评估培训模式。

英文摘要

Flexible endoscopic evaluation of swallowing (FEES) is a cornerstone of instrumental dysphagia assessment, yet substantial practice variation has been documented across clinical settings. This study aimed to characterize variation in FEES protocols and examine associations between clinician and professional characteristics, practice patterns, and confidence in interpreting clinical findings. An online survey was completed by 109 professionals with FEES experience. The final analytic sample included 97 participants. The survey assessed demographic and professional background, protocol components, examination duration, and self-rated confidence in clinical judgements. Substantial heterogeneity was found across FEES protocol components, including inconsistent incorporation of sensory testing, variable dye use, and diverse rating scale adoption. The Penetration-Aspiration Scale was used by 98.9% of respondents, while other scales showed lower adoption rates. Confidence was highest for judging aspiration presence and lowest for aspiration depth. Greater FEES-specific experience was associated with shorter examination duration (p = 0.03), but neither years of experience nor education level significantly predicted overall confidence in judgment. Physician status and higher education were significantly associated with performing formal sensory testing. FEES is implemented with considerable variability in clinical practice. Confidence in judgment appears to be influenced by the complexity of the clinical finding and the availability of structured rating tools rather than by experience or education alone. These findings support the need for clearer definition of core protocol components, development of standardized tools for complex swallowing parameters, and systematic evaluation of training models.