吞咽困难诊断中柔性内镜吞咽评估的实践模式差异：一项探索性研究

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中文摘要

目的： 本研究的目的首先是探索当前专业内部柔性内镜吞咽评估（FEES）解读实践，预期缺乏方法学共识。其次，旨在比较使用Langmore定义与视觉分析吞咽效率与安全性（VASES）定义解剖边界的FEES检查中的穿透-误吸量表（PAS）评分，假设使用Langmore框架会比VASES产生更多“异常”评分，因为其解剖边界定义更为保守。
方法： 对美国各地的FEES培训课程供应商和FEES临床从业者进行了调查，了解他们采用的解剖边界。三级医疗中心的专家评分者审查了记录的FEES检查，并使用Langmore或VASES边界评定PAS评分。统计分析比较了（a）正常与异常评分的频率，以及（b）两种框架之间PAS 1和PAS 3的频率，代表吞咽困难诊断的阈值。
结果： 在FEES检查解读方面存在显著的专业内部不一致。正常与异常PAS评分的比率存在显著差异，Langmore边界比VASES产生更多异常评分。最值得注意的是，两种框架之间PAS 1（无气道侵入）与PAS 3（持续穿透）的频率存在显著差异。
结论： 有两种框架选项指导PAS评分，它们在定义的解剖边界上不同，直接影响吞咽困难诊断。遵循最高循证实践标准的经验丰富的临床医生仍可能经常误诊吞咽困难，对患者产生广泛影响。研究结果强调需要建立一致的FEES吞咽困难诊断方法，并为提高标准化和准确性提供了具体的机遇领域。
补充材料： https://doi.org/10.23641/asha.34790430。

英文摘要

PURPOSE: The purpose of this study was, first, to explore current intraprofessional flexible endoscopic evaluation of swallowing (FEES) interpretation practices, expecting lack of methodological consensus. Second, it aimed to compare penetration-aspiration scale (PAS) ratings on FEES exams using Langmore-defined versus Visual Analysis of Swallowing Efficiency and Safety (VASES)-defined anatomical boundaries, hypothesizing that using the Langmore framework would yield more "abnormal" scores than the VASES, due to more conservatively defined anatomical boundaries.
METHOD: FEES training course vendors and FEES clinical practitioners across the United States were surveyed regarding the anatomical boundaries they employ. Expert raters at a tertiary care center reviewed recorded FEES exams and rated PAS scores using either Langmore or VASES boundaries. Statistical analyses compared (a) the frequency of normal versus abnormal scores and (b) the frequency of PAS 1 and PAS 3 between the frameworks, representing the threshold for dysphagia diagnosis.
RESULTS: There is notable intraprofessional inconsistency regarding FEES exam interpretation. There was a significant difference in the rates of normal versus abnormal PAS scores, with Langmore boundaries yielding more abnormal scores than VASES. Most notably, a significant difference was found in the frequency of PAS 1 (no airway invasion) versus PAS 3 (sustained penetration) between frameworks.
CONCLUSIONS: Two framework options guide PAS ratings, which differ in their defined anatomical boundaries, directly impacting dysphagia diagnosis. Experienced clinicians adhering to the highest standards of evidence-based practice may still regularly misdiagnose dysphagia with wide-ranging implications for patients. The findings highlight a need to establish a consistent approach to dysphagia diagnostics with FEES and offer a concrete area of opportunity for improved standardization and accuracy.
SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.34790430.