Development of the Brief Bedside Dysphagia Screening Test – Revised: a Cross-Sectional Czech Study

Abstract

Summary:Aim: The purpose of this study was to develop a revised version of the Brief Bedside Dysphagia Screening Test for determining penetration/aspiration risk in patients prone to dysphagia. The priority was to achieve high sensitivity and negative predictive value. Methods: The study screeners conducted bedside assessment of the swallowing function in 157 patients with a neurological (mainly stroke) or an ear, nose, and throat diagnosis (mainly head and neck cancer). The results were compared with a gold standard, flexible endoscopic examination of swallowing. Results: For the neurological subgroup (N = 106), eight statistically significant bedside assessment items were combined into the Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). Cut-off score 1 produced the highest sensitivity (95.5%; 95% confidence interval CI [CI]: 84.9-98.7%) and negative predictive value (88.9%; 95% CI 67.2-96.9%). Conclusion: The BBDST-R is suitable for dysphagia screening in departments caring for patients with neurological conditions.

The dysphagia stress test for rapid assessment of swallowing difficulties in esophageal conditions

“…5 Assessment of the patient's ability to swallow liquids and solids of varying consistencies can yield important information to corroborate, or contradict, self-report of dysphagia symptom location and severity, which can be inaccurate. 6,7 Although assessments of swallowing abilities exist, [8][9][10][11][12][13][14] rapid methods are limited to oropharyngeal dysphagia in non-GI patient populations. A review of these tools found most lack consistent sensitivity to identify dysphagia and are limited in generalizability due to homogeneous samples.…”

Inter-rater agreement of the Brief Bedside Dysphagia Screening Test-Revised in patients with stroke

“…One of the important decision points involves determining whether patients with stroke appear to be suffering from swallowing difficulties; to this end, various bedside screening tests have been developed (O'Horo et al, 2015). The Brief Bedside Dysphagia Screening Test-Revised (BBDST-R) is a simple 8item dysphagia screening tool with high sensitivity (95.5%; 95% confidence interval CI [CI] = 84.9-98.7%) and negative predictive value (88.9%; 95% CI = 67.2-96.9%) that is recommended for patients with neurological conditions (Mandysova et al, 2015). Both the preliminary version of the tool, the Brief Bedside Dysphagia Screening Test (BBDST) (Mandysova et al, 2011), and the BBDST-R (Mandysova et al, 2015) were developed in the Czech Republic based on a comparison of a simple bedside assessment and a quick swallow test with the gold standard, flexible endoscopic examination of swallowing.…”

“…The Brief Bedside Dysphagia Screening Test-Revised (BBDST-R) is a simple 8item dysphagia screening tool with high sensitivity (95.5%; 95% confidence interval CI [CI] = 84.9-98.7%) and negative predictive value (88.9%; 95% CI = 67.2-96.9%) that is recommended for patients with neurological conditions (Mandysova et al, 2015). Both the preliminary version of the tool, the Brief Bedside Dysphagia Screening Test (BBDST) (Mandysova et al, 2011), and the BBDST-R (Mandysova et al, 2015) were developed in the Czech Republic based on a comparison of a simple bedside assessment and a quick swallow test with the gold standard, flexible endoscopic examination of swallowing. The largest subgroup was comprised of patients with stroke (54 of 112 patients or 48%) (Mandysova et al, 2015); therefore, the BBDST-R could be ideal for use in such patients.…”

“…Both the preliminary version of the tool, the Brief Bedside Dysphagia Screening Test (BBDST) (Mandysova et al, 2011), and the BBDST-R (Mandysova et al, 2015) were developed in the Czech Republic based on a comparison of a simple bedside assessment and a quick swallow test with the gold standard, flexible endoscopic examination of swallowing. The largest subgroup was comprised of patients with stroke (54 of 112 patients or 48%) (Mandysova et al, 2015); therefore, the BBDST-R could be ideal for use in such patients. Implicit in this approach is the assumption that nurses can agree on whether the result of the screening is normal or abnormal.…”

“…Therefore, determining the inter-rater reproducibility (agreement) of dysphagia screening tests used by nurses with varying levels of experience is important. The BBDST-R, as a valid tool, has already been implemented in clinical practice (Mandysova et al, 2015). However, its inter-rater agreement has been reported only in a brief form (Mandysova, 2014), which is insufficient given the complexity of this measure.…”