多伦多床旁吞咽筛查试验在急性期脑卒中后吞咽障碍筛查中的筛检效果评价

目的:探讨多伦多床旁吞咽筛查试验(TOR-BSST)在急性期脑卒中后吞咽障碍筛查中的筛检效果。方法:采用TOR-BSST对148例急性期脑卒中后住院患者进行筛查评估,筛查当天或24小时之内行吞咽障碍诊断金标准——视频透视检查(VFSS),以金标准为参考标准,用灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比进行筛检效果评价。结果:TOR-BSST(+)共46例(31.08%),TOR-BSST(-)共102例(68.92%),结果显示TOR-BSST判断吞咽障碍的灵敏度为61.8%,特异度为87.1%,阳性预测值为73.9%,阴性预测值79.4%,阳性似然比为4.7907,阴性似然比0.4386。结论:与TOR-BSST研发原作者的研究相比较,此研究结果显示筛检效果不够理想,两者的研究环境与使用环境均有差距,未来需要更严谨的研究方法学设计、更多的吞咽障碍评估方法的引进或开发,且加强VFSS评价的准确性是关键。

Clinical study of the accuracy of the Toronto bedside swallowing screening test in screening of acute stroke patients with dysphagia

Abstract Objective: To study the accuracy of the Toronto bedside swallowing screening test (TOR-BSST) in screening of acute stroke patients with dysphagia. Method: One hundred and forty-eight in-patients with acute cerebral vascular accident were assessed with TOR-BSST. As a golden standard for evaluation of dysphagia, videofluoroscopic swallowing studies (VFSS) test was used to judge the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of TOR-BSST. Result: Forty-six (31.08%) and 102 patients (68.92%) were screened with positive and negative TOR-BSST results respectively. The sensitivity and specificity of TOR-BSST in screening dysphagia was 61.8% and 87.1%, respectively. The positive predictive value was 73.9% while the negative predictive value was 79.4%. Positive likelihood ratio was 4.7907. Negative likelihood ratio was 0.4386. Conclusion: In the present study, the accuracy of TOR-BSST is not as satisfactory as the one reported by Marino. The different results may be due to the different culture and the settings under which the instrument was used. It is suggested a more rigorous research methodology design combined with introduction of alternatives of dysphagia evaluation. And strengthening the accuracy of VFSS evaluation also should be the key point.