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Published on: March 1, 2015
Measurement properties of instruments for post-extubation dysphagia in critically ill patients: A systematic review
Lilly Koppelkamm1, Martin Eicher2, Peter Nydahl3
1Charité - University Medical Center Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Augustenburger Platz 1, 13353 Berlin, Germany.
Objectives:
Post-extubation dysphagia (PED) is a common but often under-recognised complication in critically ill patients following invasive mechanical ventilation. Systematic assessment of PED in routine ICU practice is not common. This systematic review aimed to identify clinical instruments used to assess PED in critically ill adult patients and to evaluate their measurement properties.
Methods:
This review was conducted in accordance with the COSMIN methodology for systematic reviews of measurement instruments. A comprehensive evidence search was performed in multiple databases and other sources. Studies were included if they developed or applied standardised assessment instruments for the identification of PED in critically ill adults (≥18 years).
Results:
Of 2769 abstracts reviewed, 22 studies met criteria for inclusion. Sixteen different instruments for the assessment of PED were identified. These were categorised into water swallow tests, multi-consistency tests, and assessments without a swallowing evaluation. For nine instruments, measurement properties were reported, focusing on content validity, criterion validity and reliability, and demonstrated mostly good measurement properties. The Post-Extubation Dysphagia Screening Tool was the only evaluated across all three properties and showed sufficient measurement properties. The overall quality of evidence was mostly low to very low.
Conclusions:
There are various clinical assessment instruments for PED in critically ill adults. Most instruments showed good criterion validity, indicating their potential for clinical use. However, other measurement properties are largely unknown, and the quality of evidence is generally low. Thus, it is currently unclear which tool is best suited for assessing PED. Further research investigating validity and reliability is needed to identify instruments suitable for routine ICU use.
Implications For Clinical Practice:
Systematic detection of PED is important. Assessment instruments with good diagnostic performance should be used to improve ICU care.
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