嚥下障害のスクリーニングテストの系統的レビュー

嚥下障害のスクリーニングテストの系統的レビューに関する論文を紹介します。

Bours GJ, Speyer R, Lemmens J, Limburg M, de Wit R: Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs. 2009 Mar;65(3):477-93.

Second international course on oropharyngeal dysphagiaではRenee Speyerさんがこの論文の紹介をしてくれました。

検索の結果、35論文が選定されましたが、その中で論文の質が高い11論文のみが系統的レビューの対象となっています。この時点で日本の論文がないことが残念です。また、頸部聴診法の論文もほとんどありません。次に感度70％、特異度60％以上を意味のあるスクリーニングとしています。

その結果、水飲みテストにパルスオキシメーターを併用する方法が、感度73～98%、特異度63～76%と比較的高く、もっとも効果的なスクリーニングテストだとしています。ただし、この論文の後に、先日紹介したV-VSTの論文が出ていますので、水飲みテスト＋パルスオキシメーターよりもV-VSTのほうがよいというのが現状です。

単に英語の論文で発表というだけでなく、研究の質が高くないと相手にしてもらえないというサイエンスの現状を改めて感じました。

Abstract
AIM: This paper is a report of a systematic review conducted to determine the effectiveness and feasibility of bedside screening methods for detecting dysphagia in patients with neurological disorders.

BACKGROUND: Dyspaghia affects 22-65% of patients with neurological conditions. Although there is a large variety of bedside tests to detect dysphagia, it is unknown which have the best psychometric properties and are feasible for nurses to use. DATA SOURCES AND REVIEW METHODS: An electronic database search was carried out using Medline (PubMed), Embase, CINAHL, and PsychLit, including all hits up to July 2008. The search terms were dysphagia, sensitivity, specificity, diagnosis, and screening. The methodological quality of included studies was assessed.

RESULTS: Thirty-five out of 407 studies were included in the review. Eleven studies with sufficient methodological quality revealed that trial swallow tests using water had sensitivities between 27% and 85% and specificities between 63% and 88%. Trial swallow tests with different viscosities led to sensitivities ranging from 41% to 100% and specificities of 57% to 82%. Combining water tests with oxygen desaturation led to sensitivities between 73% and 98% and specificities between 63% and 76%. Single clinical features, such as abnormal gag, generally had low sensitivity and specificity.

CONCLUSION: A water test combined with pulse oximetry using coughing, choking and voice alteration as endpoints is currently the best method to screen patients with neurological disorders for dysphagia. Further research is needed to establish the most effective standardized administration procedure for such a water test, and to assess the value of pulse oximetry, in addition to a trial swallow to detect silent aspiration.