Discriminant Ability of the Eating Assessment Tool-10 to Detect Swallowing Safety and Efficiency Impairments.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Quick, sensitive dysphagia screening tools are necessary to identify high-risk patients for further evaluation in busy multidisciplinary amyotrophic lateral sclerosis (ALS) clinics. We examined the relationship between self-perceived dysphagia using the validated Eating Assessment Tool-10 (EAT-10) and videofluoroscopic analysis of swallowing safety and efficiency. STUDY DESIGN: Prospective, observational, longitudinal study. METHODS: Individuals with ALS completed the EAT-10 and a videofluoroscopic swallowing study. Duplicate, independent, blinded analyses of the validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale were performed to index swallowing safety and efficiency (mild dysphagia DIGEST ≥ 1, moderate dysphagia DIGEST ≥ 2). A between-groups analysis of variance with Games-Howell test for post-hoc pairwise comparisons was performed to examine EAT-10 scores across dysphagia severity levels. Receiver operator characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, positive-negative predictive values (PPV, NPV), and odds ratios (OR) were derived. RESULTS: Four hundred and thirty five paired EAT-10 and DIGEST scores were analyzed. Mean EAT-10 score was 8.48 (95% confidence interval [CI] 7.63-9.33). Individuals with dysphagia demonstrated higher EAT-10 scores (mild 4.1 vs. 11.3, moderate 6.0 vs. 17.5, P < .001). Mean EAT-10 scores increased across DIGEST levels (D0 4.1, D1 7.9, D2 15.1, D3 20.4, D4 39.0). For mild dysphagia, an EAT-10 cut score of 3 was optimal AUC 0.74 (95% CI 0.69-0.78; sensitivity 77%; specificity 53%; PPV 71%; NPV 60%; OR 3.5). An EAT-10 cut score of 7 optimized detection of moderate dysphagia AUC 0.83 (95% CI 0.78-0.87; sensitivity 81%; specificity 66%; PPV 39%; NPV 93%; OR 8.1). CONCLUSION: The EAT-10 is an easy-to-administer dysphagia screening tool with good discriminant ability for use in ALS clinics. LEVEL OF EVIDENCE 2 Laryngoscope, 1322319-2326, 2022.