Development of the Brief Bedside Dysphagia Screening Test in the Czech Republic

Abstract

In patients who are prone to impaired swallowing, dysphagia screening has been advocated. However, most dysphagia screening tests are lacking gold-standard validation and nurse screeners. The purpose of this study was to develop a nursing dysphagia screening test to determine the penetration or aspiration risk in patients with neurological and ear, nose, and throat conditions. Eighty-seven Czech patients underwent a bedside assessment by nurse screeners. A comparison of the results to the gold standard, flexible endoscopic examination of swallowing, identified eight "important" or "marginal" assessment items, which were combined into one test, called the Brief Bedside Dysphagia Screening Test: "ability to clench the teeth"; "symmetry/strength of the tongue"; "symmetry/strength of the facial muscles"; "symmetry/strength of the shoulder shrug"; "dysarthria"; "thick liquid: choking"; "thick liquid: dripping from the mouth"; and "thick liquid: cough". The sensitivity, specificity, and negative predictive value of the Brief Bedside Dysphagia Screening Test were: 87.1%, 30.4%, and 81%, respectively, in all patients; 95.2%, 27.5%, and 93.3%, respectively, in patients with neurological conditions; and 60%, 60%, and 42.9%, respectively, in patients with ear, nose, and throat conditions. The test is more suitable for patients with neurological conditions than for more heterogeneous patient populations.

Development of the Brief Bedside Dysphagia Screening Test – Revised: a Cross-Sectional Czech Study

“…However, both parameters were lower in the ear, nose, and throat (ENT) subgroup (17). Consequently, overall sensitivity (87.1%; 95% CI: 71.1-94.9%) and negative predictive value (81.0%; 95% CI: 60.0-92.3%) were lower (17). Clearly, the heterogeneity of the patients was an impediment to achieving high diagnostic parameters.…”

“…The minimal sample size for the group of "cases" (N cases ) is read from the provided tables, and the corresponding number of "controls" (N controls ) is obtained from an equation that assumes disease prevalence (Prev) < 50%: (20). For the purpose of this study, the disease (dysphagia) prevalence assumption was based on the relative frequency of abnormal FEES in the pilot study, which was 35.6% for all patients and 29.2% for the neurological subgroup (17). Therefore, the above Equation 1 could be used.…”

“…Inpatients were recruited via nurses or physicians on the wards; outpatients were recruited during their visits to the dysphagia clinic (17). The inclusion criteria were: prone to dysphagia based on the primary neurological or ENT diagnosis; receiving care in one of the mentioned departments; medically stable (not receiving care in the intensive care unit); sufficiently alert (able to follow simple commands); able to maintain a sitting position; able to sign an informed consent (17).…”

“…The most widely recognized gold standards are videofluoroscopy and flexible endoscopic evaluation of swallowing (FEES) (3). The use of a gold standard enables comparisons with bedside assessments and subsequent selection of assessment items for the DSI (17).…”

“…The Brief Bedside Dysphagia Screening (BBDS) Test was the result of a study aiming to a) develop a DSI while using FEES (the gold standard) on all enrolled patients, and b) enroll patients with various conditions predisposing to penetration/aspiration (17) (17). However, both parameters were lower in the ear, nose, and throat (ENT) subgroup (17).…”