EAT-10 to Screen Instrumentally Confirmed Dysphagia Following Anterior Cervical Spine Surgery

We aimed to profile patient-perceived swallowing impairment before and after otolaryngology-assisted anterior cervical spine surgery (ACSS) and the discriminant ability of a validated patient-reported Eating Assessment Tool-10 (EAT-10) to detect instrumentally confirmed (IC) dysphagia.

This was a prospective single-site study of clinically referred adults undergoing otolaryngology-assisted ACSS who completed the EAT-10 survey and a fiberoptic endoscopic evaluation of swallowing (FEES) before and after surgery. Validated metrics of swallowing safety (Penetration Aspiration Scale, PAS) and efficiency (Yale Pharyngeal Residue Severity Rating Scale, YPRSRS) were completed. Dysphagia was operationally defined as YPRSRS = mild, moderate, or severe and/or a PAS ≥ 6. A Wilcoxon signed-rank test, exact McNemar's test, logistic regression, and receiver operating characteristic (ROC) analysis with area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were conducted.

Sixty-four participants were included. Mean age was 57.6 (SD = 11.1), 45.3% were male, and 82.8% were revision ACSS. On average, EAT-10 score worsened by 6.0 points following ACSS, p < 0.001, and dysphagia doubled from 15.6% to 34.4% across pre- to post-ACSS timepoints, p < 0.01. ROC analysis demonstrated moderate discriminative ability for the EAT-10 to accurately classify IC dysphagia (AUC = 0.68). An EAT-10 cut score of ≥ 7 yielded: sensitivity of 72.7%, specificity of 64.3%, PPV of 51.6%, and NPV of 81.8%.

Patient-perceived swallowing impairment increased following otolaryngology-assisted ACSS and was associated with IC dysphagia. In conjunction with other bedside screening tools, the EAT-10 could serve as a useful patient-reported outcome for this population vulnerable to dysphagia.

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