Diagnostic accuracy of the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG) compared to Flexible Endoscopic Evaluation of Swallowing (FEES) for assessing dysphagia in hospitalized geriatric patients - a diagnostic study.

BACKGROUND: Oropharyngeal dysphagia is highly prevalent among hospitalized geriatric patients. The screening instruments used to date have been evaluated primarily in stroke patients. This diagnostic study aimed to validate a new screening instrument for oropharyngeal dysphagia, the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG), as compared to one of the gold standards, flexible endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS: Geriatric inpatients admitted to five geriatric hospitals in Germany were consecutively evaluated using both DSTG and FEES in random order and by different evaluators blinded to the results of the other evaluation. In the FEES examination, a score of more than 3 on Rosenbek's Penetration Aspiration Scale was considered evidence of clinically relevant oropharyngeal dysphagia. Sensitivity, specificity and further measures of test performance were calculated for DSTG. RESULTS: The 53 volunteers recruited were on average 85 years of age, 56.6% were women. Twenty patients (37.7%) were diagnosed with dysphagia using FEES. Of these, 12 were screened as positive on DSTG. Of the 33 FEES negative patients, 4 tested positive on DSTG. The following test parameters were calculated for DSTG: sensitivity: 0.60, 95% confidence interval [0.39 ; 0.78], specificity 0.88 [0.73 ; 0.95], positive predictive value 0.75 [0.51 ; 0.90], negative predictive value 0.78 [0.63 ; 0.89], positive likelihood ratio 4.95 [1.85 ; 13.27], negative likelihood ratio 0.46 [0.26 ; 0.79]. In a receiver-operator characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.77 [0.62 ; 0.91]. No adverse events occurred. CONCLUSION: The DSTG appears to be a valid instrument for screening of oropharyngeal dysphagia in geriatric inpatients.

[Development of a new screening instrument for screening of dysphagia in geriatric patients: the dysphagia screening tool geriatrics]. / Entwicklung eines neuen Screeninginstruments zum Screening auf Dysphagie bei geriatrischen Patienten: das Dysphagie Screening-Tool Geriatrie.

BACKGROUND: Oropharyngeal dysphagia is widespread in geriatric patients and is nearly always multicausal. It is often insufficiently recognized and leads to severe complications. The available and established screening tools all focus primarily on patients with neurological diseases, usually following a stroke. MATERIAL AND METHODS: The working group on dysphagia of the German Society of Geriatrics (DGG), which is comprised of physicians, speech and language therapists and dysphagia therapists, performed a literature review on dysphagia screening tools. Based on the results of the literature search and own experience, a new screening instrument suitable for geriatric patients was developed and agreed by the consensus group. RESULTS: The new screening instrument for the detection of oropharyngeal dysphagia in geriatric patients consists of three parts: 1) consciousness and posture control while sitting, 2) ability to swallow saliva and to cough as well as tongue motility and 3) the water swallowing test. The screening can be applied by trained medical personnel and can easily be integrated into everyday practice. CONCLUSION: The new screening tool is especially aimed at geriatric patients. It has advantages compared to previously recommended screening tests. Initial experiences with the instrument show good practicability and acceptance in geriatric teams. Further studies have to test the validity of the instrument.

Safety and clinical impact of FEES - results of the FEES-registry.

BACKGROUND: At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. METHODS: Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. RESULTS: 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson's disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist's previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. DISCUSSION: This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients' clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03037762, registered January 31st 2017.