J Korean Dysphagia Soc.  2013 Jan;3(1):20-25.

Development and Validation of a New Screening Test for Dysphagia

Affiliations
  • 1Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Yesan County Health Center, Chungnam, Korea
  • 3Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

Abstract


Objective
To develop a new screening test for dysphagia patients with various etiologies. Method: We investigated 10 widely used screening tests based on previous studies. Contents of the screening tests were summarized into 76 items. By using modified Delphi technique, 23 items showing high average score (>3.5) were selected as candidates for the new Clinical Dysphagia Scale (nCDS). A total of 216 dysphagia patients with various etiologies were tested with these items and underwent videofluoroscopic swallowing study (VFSS) simultaneously. We analyzed these data in statistical and clinical aspects to determine which items were more correlated with VFSS findings and which items are more appropriate for the screening test. Content validity was re-evaluated by consensus in an expert meeting. Consequentially, 8 items were selected for the nCDS. Result: The nCDS included 8 items: swallowing difficulty, structural defect (oral cavity, pharynx, larynx, or esophagus), lip sealing, tongue movement (forward and side to side), saliva swallowing, wet voice or gurgling voice (pre-swallowing), 5 ml water swallowing test (2 times), and laryngeal elevation during swallowing. The sensitivity and specificity of the nCDS score for detecting necessity of food modification were 83.8% and 58.3%, respectively. It was also well correlated with the functional dysphagia scale derived from the VFSS (Pearson's coefficient 0.525, P <0.01).
Conclusion
The nCDS is not only a good screening test for detecting necessity of food modification, but also a good diagnostic tool for evaluation of general swallowing function. Furthermore, it is simply applicable to dysphagic patients with various etiologies.

Keyword

Deglutition disorders; Symptom assessment; Sensitivity; pecificity
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