Article

OBJECTIVE: To assess the accuracy of bedside swallow evaluation (BSE) compared
with videofluorosopic swallow study (VFSS) in diagnosing dysphagia in individuals
with tetraplegia due to spinal cord injury (SCI). DESIGN: A prospective
diagnostic accuracy study according to STAndards for the Reporting of Diagnostic
accuracy studies (STARD) criteria. SETTING: A county hospital with acute
inpatient SCI unit. PATIENTS: Thirty-nine subjects with SCI and tetraplegia were
enrolled. All of the subjects underwent BSE, and 26 subjects completed the VFSS.
METHODS: Individuals with SCI underwent a BSE followed by a VFSS within 72 hours
of the BSE. The subjects were diagnosed as having dysphagia if they had positive
findings in either BSE or VFSS. MAIN OUTCOME MEASURES: Sensitivity, specificity,
and positive and negative predictive values were calculated by using VFSS as the
criterion standard. RESULTS: Fifteen subjects (38%) were diagnosed as having
dysphagia based on the BSE results. Among the subjects who completed the VFSS, 11
were diagnosed with dysphagia (42%) and 4 were diagnosed with aspiration (10%).
Of the 26 subjects who completed both BSE and VFSS, only 1 subject was diagnosed
differently compared with BSE (3.8%). Different diet recommendations were made in
4 cases after VFSS versus BSE. Different liquid recommendations were made in 8
cases after VFSS versus BSE. Sensitivity of BSE was 100% (95% confidence interval
[CI], 71.5%-100%), specificity was 93.3% (95% CI, 68.1%-99.8%). A positive
predictive value of BSE was 91.7% (95% CI, 61.5%-100%), and the negative
predictive value was 100% (95% CI, 76.8%-100%). CONCLUSIONS: Dysphagia is present
in approximately 38% of individuals with acute tetraplegia. Because only one of
the 21 subjects was diagnosed differently based on VFSS, we believe that BSE is
an appropriate screening tool for dysphagia for individuals with cervical SCI.
However, VFSS provided additional information on diet and liquid recommendations,
so there appears to be an important clinical role for the VFSS.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS