Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia

L Rofes, V Arreola, R Mukherjee, P Clavé, L Rofes, V Arreola, R Mukherjee, P Clavé

Abstract

Background: Oropharyngeal dysphagia (OD) is an underdiagnosed digestive disorder that causes severe nutritional and respiratory complications. Our aim was to determine the accuracy of the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST) for clinical evaluation of OD.

Methods: We studied 120 patients with swallowing difficulties and 14 healthy subjects. OD was evaluated by the 10-item screening questionnaire EAT-10 and the bedside method V-VST, videofluoroscopy (VFS) being the reference standard. The V-VST is an effort test that uses boluses of different volumes and viscosities to identify clinical signs of impaired efficacy (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallow (cough, voice changes, and oxygen desaturation ≥3%). Discriminating ability was assessed by the AUC of the ROC curve and sensitivity and specificity values.

Key results: According to VFS, prevalence of OD was 87%, 75.6% with impaired efficacy and 80.9% with impaired safety of swallow including 17.6% aspirations. The EAT-10 showed a ROC AUC of 0.89 for OD with an optimal cut-off at 2 (0.89 sensitivity and 0.82 specificity). The V-VST showed 0.94 sensitivity and 0.88 specificity for OD, 0.79 sensitivity and 0.75 specificity for impaired efficacy, 0.87 sensitivity and 0.81 specificity for impaired safety, and 0.91 sensitivity and 0.28 specificity for aspirations.

Conclusions & inferences: Clinical methods for screening (EAT-10) and assessment (V-VST) of OD offer excellent psychometric proprieties that allow adequate management of OD. Their universal application among at-risk populations will improve the identification of patients with OD at risk for malnutrition and aspiration pneumonia.

Keywords: ROC curve; deglutition disorders; screening; sensitivity; specificity.

© 2014 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
V-VST algorithm. Patients with safe swallow started the exploration with a 5 mL nectar bolus, followed by 10 and 20 mL nectar boluses, then performed the thin liquid series with boluses of increasing volume and finally completed the pathway with the three EST boluses to explore efficacy of swallow. If the patient presented signs of impaired safety at nectar or thin liquid viscosities, the series was interrupted and the EST series was assessed. EST, extreme spoon-thick.
Figure 2
Figure 2
Flowchart of subjects included in the study that underwent the EAT-10. Subjects stratified by presence of oropharyngeal dysphagia according to the VFS study.
Figure 3
Figure 3
Flowchart of subjects included in the study that underwent the first V-VST. (A) Subjects stratified by presence of oropharyngeal dysphagia according to the VFS study. (B) Subjects stratified by presence of signs of impaired safety of swallow (penetrations, aspirations, and safe swallow) according to the VFS study. Note that the test was performed twice, to calculate sensitivity and specificity values of the V-VST, so a subject-specific random-effect term was added to the beta-binomial model to obtain the mixed-effect model.
Figure 4
Figure 4
ROC curves of EAT-10 to detect dysphagia, impaired efficacy, and impaired safety of swallow with respect to VFS findings.

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