The Toronto Bedside Swallowing Screening Test (TOR-BSST)
| Autor: | Gordon Nicholson, Robert Teasell, Frank L. Silver, David L. Streiner, Rosemary Martino, Mark Bayley, Nicholas E. Diamant |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Point-of-Care Systems medicine.medical_treatment Test validity Swallowing Predictive Value of Tests medicine Humans Stroke Aged Advanced and Specialized Nursing Rehabilitation Esophageal disease business.industry Gold standard Reproducibility of Results Middle Aged medicine.disease Dysphagia Deglutition Treatment Outcome Data Interpretation Statistical Predictive value of tests Physical therapy Female Neurology (clinical) medicine.symptom Deglutition Disorders Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | Stroke. 40:555-561 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.107.510370 |
| Popis: | Background and Purpose—Dysphagia occurs in 55% of all acute stroke patients. Early identification of dysphagia from screening can lead to earlier treatments and thereby reduce complications. We designed and validated a new bedside dysphagia screening tool—the Toronto Bedside Swallowing Screening Test (TOR-BSST) for stroke survivors in acute and rehabilitative settings.Methods—The TOR-BSST initially contained 5 items with proven high predictive ability for dysphagia. Trained screeners administer and score the TOR-BSST in less than 10 minutes. Trained nurses from 2 acute and 2 rehabilitation facilities administered the TOR-BSST to consecutively admitted stroke inpatients. A positive screen identified patients at risk for dysphagia. Blinded repeat screenings were conducted within 24 hours. Test-retest reliability was established with the first 50 administrations at an ICC=0.92 (CI, 0.85 to 0.96). Items were eliminated if they contributed ≤5% to the total score and were judged clinically impractical. 20% of all enrolled patients were randomly allocated to gold standard videofluoroscopic assessment of swallowing and findings rated independently by 4 blinded experts. Adequate validity was set at sensitivity ≥90% and negative predictive value ≥90%.Results—311 stroke inpatients were enrolled; 103 acute and 208 rehabilitation. Screening was positive in 59.2% acute and 38.5% rehabilitation patients. The pharyngeal sensation item did not meet inclusion criteria and was eliminated. The TOR-BSST demonstrated excellent validity with sensitivity at 91.3% (CI, 71.9 to 98.7), and negative predictive values at 93.3% in acute and 89.5% in rehabilitation settings.Conclusion—The TOR-BSST is a simple accurate tool to identify stroke patients with dysphagia regardless of severity and setting. |
| Databáze: | OpenAIRE |
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