Assessment Tools for Intensive Care Unit-Acquired Dysphagia: A Network Meta-Analysis of Diagnostic Accuracy Studies

This study aims to determine the diagnostic accuracy for assessment tools as compared to reference standard in Intensive Care Unit-Acquired Dysphagia (ICUAD) using network meta-analysis. Comprehensive searches of PubMed, Embase, and Web of Science were conducted from database inception before May 2025 to identify studies on ICUAD assessment tools. Two reviewers independently performed study screening, data extraction, and quality assessment. All analyses were implemented in R version 4.3.2. True positives (TP), False positives (FP), True negatives (TN), False negatives (FN), Sensitivity, Specificity, Positive predictive value (PPV), and Negative predictive value (NPV) were calculated and used to rank the index tests. Nineteen studies involving 1,167 patients and 11 tools were analyzed. The gold standards, Video Fluoroscopic Swallow Study (VFSS) and Flexible Endoscopic Examination of Swallowing (FEES), showed the highest accuracy. Among bedside tools, the Gugging Swallowing Screen (GUSS) (32.55%) and Standardized Swallowing Assessment (SSA) (42.26%) achieved the best balance of sensitivity and specificity, followed by the modified Volume-Viscosity Swallow Test (mV-VST) (30.07%). GUSS and SSA are practical and reliable bedside tools for ICUAD screening, but cannot replace VFSS or FEES. Further large-scale high-quality prospective studies are needed to confirm their diagnostic performance.