Sensitivity and Specificity of the Yale Swallow Protocol in Recently Extubated Patients.

IF 2.3 3区 医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
Stevie Marvin, Susan Thibeault, William Ehlenbach
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引用次数: 0

Abstract

Purpose: The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients.

Method: One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test. Failure was defined as interrupted drinking or immediate cough after drinking. FEES exams were rated using the Penetration Aspiration Scale. Fisher's exact test and t test were used to test for association between failure on the YSP and participant factors (sex, age, reason for admission/intubation, duration of intubation, number of intubations, and time post-extubation of exam), aspiration on FEES and participant factors, and a false negative on the YSP and participant factors.

Results: Fifty-seven percent (88 of 154) failed the YSP. Fifty percent (77 of 154) of participants aspirated on at least one trial during the FEES. Sensitivity of the YSP was 75%, and specificity was 61%. Participants who failed the YSP were older (M = 61 years; p = .0030). More women failed the YSP than men (p = .0007). No patient factors were associated with aspiration on FEES. Participants admitted for respiratory etiologies (pneumonia, chronic obstructive pulmonary disease exacerbation) were most likely to have a false negative on the YSP (p = .02). False negatives were also more likely in participants with a size ≥ 8 of endotracheal tube (p = .03).

Conclusions: The YSP has suboptimal sensitivity and specificity for detecting aspiration in recently extubated patients. More data are needed on predictors of false negatives in order to improve sensitivity and specificity in this critically ill patient population.

耶鲁吞咽方案在近期拔管患者中的敏感性和特异性。
目的:本研究的目的是确定耶鲁吞咽方案(YSP)检测近期拔管患者误吸的敏感性和特异性。方法:154例患者在拔管后48小时内随机进行YSP和光纤内镜吞咽评估(FEES)。YSP包括定向问题、口头运动测试和3盎司水吞测试。失败定义为饮酒中断或饮酒后立即咳嗽。收费考试采用渗透期望量表进行评分。使用Fisher精确检验和t检验来检验YSP失败与参与者因素(性别、年龄、入院/插管原因、插管持续时间、插管次数和拔管后检查时间)、FEES和参与者因素的误吸以及YSP和参与者因素的假阴性之间的相关性。结果:57%(88 / 154)患者未通过YSP检查。50%(154名参与者中的77名)的参与者在试验期间至少进行了一次抽吸。YSP的敏感性为75%,特异性为61%。未通过YSP的参与者年龄较大(M = 61岁;P = .0030)。YSP失败的女性多于男性(p = .0007)。没有患者因素与FEES误吸相关。因呼吸系统病因(肺炎、慢性阻塞性肺疾病加重)入院的参与者最有可能在YSP上出现假阴性(p = 0.02)。气管内管尺寸≥8的受试者也更容易出现假阴性(p = .03)。结论:YSP检测近期拔管患者误吸的灵敏度和特异性均不理想。为了提高这一危重患者群体的敏感性和特异性,需要更多关于假阴性预测因子的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Speech-Language Pathology
American Journal of Speech-Language Pathology AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION
CiteScore
4.30
自引率
11.50%
发文量
353
审稿时长
>12 weeks
期刊介绍: Mission: AJSLP publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communication and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. AJSLP seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work. Scope: The broad field of speech-language pathology, including aphasia; apraxia of speech and childhood apraxia of speech; aural rehabilitation; augmentative and alternative communication; cognitive impairment; craniofacial disorders; dysarthria; fluency disorders; language disorders in children; speech sound disorders; swallowing, dysphagia, and feeding disorders; and voice disorders.
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