Diagnostic validity of methods for assessment of swallowing sounds: a systematic review

Abstract Introduction: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. Objective: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. Methods: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Results: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. Conclusion: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.【摘要引言】口咽吞咽障碍（oropharyngeal dysphagia）是神经系统患者中极为常见的共病，可造成严重健康威胁，甚至引发吸入性肺炎，病情严重程度可从住院治疗直至死亡。本评估提出一种非侵入性的基于声学的检测方法，用以区分存在吞咽渗透与误吸信号与无该信号的人群。 研究目的：本系统综述旨在评估各类吞咽声音评估方法的诊断效度，并以用于检测口咽吞咽障碍的吞咽电视透视检查（videofluroscopy swallowing study）为参照标准。 研究方法：本研究在5个电子数据库中检索以评估吞咽声音诊断准确性为核心目标的文献，检索未设语言与时间限制。研究中提及的准确性指标经转换后，借助Review Manager 5.2软件（丹麦哥本哈根北欧科克伦中心）绘制受试者工作特征（receiver operating characteristic, ROC）曲线与森林图。采用诊断准确性研究质量评价工具-2（Quality Assessment Tool for Diagnostic Accuracy Studies-2, QUADAS-2）对纳入研究的方法学质量进行评价。 研究结果：最终电子检索共获得554条记录，但仅3项研究符合纳入标准。各类检测方式的准确性指标（曲线下面积）分别为：麦克风式0.94、多普勒式0.80、听诊器式0.60。 研究结论：针对本次系统综述检索到的所有目标检测方法，结合有限的证据与偏低的方法学质量——因纳入研究数量少且样本量偏小——，多普勒式吞咽声音检测展现出极佳的诊断准确性；麦克风式检测对吞咽障碍患者的吞咽声音识别准确度良好；而听诊器式检测则是最优的筛查手段。