EAT-10用于筛查颈椎前路手术后经仪器确认的吞咽困难

文献信息

中文摘要

目的： 我们旨在描述患者在耳鼻喉科协助的颈椎前路手术（ACSS）前后自感吞咽障碍的特征，以及经验证的患者报告版进食评估工具-10（EAT-10）检测经仪器确认（IC）吞咽困难的判别能力。
方法： 这是一项前瞻性单中心研究，纳入临床转诊并接受耳鼻喉科协助ACSS的成人患者，他们在手术前后完成EAT-10问卷和纤维optic内镜吞咽评估（FEES）。完成了经验证的吞咽安全性指标（穿透-误吸量表，PAS）和吞咽效率指标（耶鲁咽部残留严重程度评定量表，YPRSRS）。吞咽困难的操作性定义为YPRSRS=轻度、中度或重度，和/或PAS≥6。进行了Wilcoxon符号秩检验、精确McNemar检验、logistic回归，以及受试者工作特征（ROC）分析，包括曲线下面积（AUC）、敏感性、特异性、阳性预测值和阴性预测值（PPV、NPV）。
结果： 共纳入64名参与者。平均年龄为57.6岁（SD=11.1），45.3%为男性，82.8%为翻修ACSS。平均而言，ACSS后EAT-10评分恶化6.0分，p<0.001；从ACSS前到ACSS后时间点，吞咽困难从15.6%翻倍至34.4%，p<0.01。ROC分析显示EAT-10对IC吞咽困难的准确分类具有中等判别能力（AUC=0.68）。EAT-10切分点≥7时：敏感性为72.7%，特异性为64.3%，PPV为51.6%，NPV为81.8%。
结论： 在耳鼻喉科协助的ACSS后，患者自感吞咽障碍增加，并与IC吞咽困难相关。与其他床旁筛查工具结合使用时，EAT-10可作为这一易患吞咽困难人群的有用患者报告结局。
证据等级： 2。

英文摘要

OBJECTIVES: We aimed to profile patient-perceived swallowing impairment before and after otolaryngology-assisted anterior cervical spine surgery (ACSS) and the discriminant ability of a validated patient-reported Eating Assessment Tool-10 (EAT-10) to detect instrumentally confirmed (IC) dysphagia.
METHODS: This was a prospective single-site study of clinically referred adults undergoing otolaryngology-assisted ACSS who completed the EAT-10 survey and a fiberoptic endoscopic evaluation of swallowing (FEES) before and after surgery. Validated metrics of swallowing safety (Penetration Aspiration Scale, PAS) and efficiency (Yale Pharyngeal Residue Severity Rating Scale, YPRSRS) were completed. Dysphagia was operationally defined as YPRSRS = mild, moderate, or severe and/or a PAS ≥ 6. A Wilcoxon signed-rank test, exact McNemar's test, logistic regression, and receiver operating characteristic (ROC) analysis with area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were conducted.
RESULTS: Sixty-four participants were included. Mean age was 57.6 (SD = 11.1), 45.3% were male, and 82.8% were revision ACSS. On average, EAT-10 score worsened by 6.0 points following ACSS, p < 0.001, and dysphagia doubled from 15.6% to 34.4% across pre- to post-ACSS timepoints, p < 0.01. ROC analysis demonstrated moderate discriminative ability for the EAT-10 to accurately classify IC dysphagia (AUC = 0.68). An EAT-10 cut score of ≥ 7 yielded: sensitivity of 72.7%, specificity of 64.3%, PPV of 51.6%, and NPV of 81.8%.
CONCLUSION: Patient-perceived swallowing impairment increased following otolaryngology-assisted ACSS and was associated with IC dysphagia. In conjunction with other bedside screening tools, the EAT-10 could serve as a useful patient-reported outcome for this population vulnerable to dysphagia.
LEVEL OF EVIDENCE: 2.