Discriminant ability of the Eating Assessment Tool‐10 to detect aspiration in individuals with amyotrophic lateral sclerosis

Abstract

Background Oropharyngeal dysphagia is prevalent in individuals with amyotrophic lateral sclerosis (ALS) leading to malnutrition, aspiration pneumonia and death. These factors necessitate early detection of at risk patients to prolong maintenance of safe oral intake and pulmonary function. This study aimed to evaluate the discriminant ability of the Eating Assessment Tool (EAT-10) to identify ALS patients with unsafe airway protection during swallowing. Methods 70 ALS patients completed the EAT-10 survey and underwent a standardized videofluoroscopic evaluation of swallowing (VFES). Two blinded raters determined airway safety using the Penetration Aspiration Scale (PAS). A between groups ANOVA (safe vs. penetrators vs. aspirators) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios calculated. Key Results Mean EAT-10 scores for safe swallowers, penetrators and aspirators (SEM) were: 4.28 (0.79) vs. 7.10 (1.79) vs. 20.50 (3.19) respectively with significant differences noted for aspirators vs. safe swallowers and aspirators vs. penetrators (p<0.001). The EAT-10 demonstrated good discriminant ability to accurately identify ALS penetrator/aspirators (PAS≥3) with a cut off score of 3 (AUC:0.77, sensitivity: 88%, specificity: 57%). The EAT-10 demonstrated excellent accuracy at identifying aspirators (PAS≥6) utilizing a cut off score of 8 (AUC:0.88, sensitivity: 86%, specificity: 72%, likelihood ratio: 3.1, negative predictive value: 95.5%). Conclusions and Inferences The EAT-10 differentiated safe vs. unsafe swallowing in ALS patients. This patient self-report scale could represent a quick and meaningful aide to dysphagia screening in busy ALS clinics for the identification and referral of dysphagic patients for further instrumental evaluation.

The Ability of the Eating Assessment Tool-10 to Detect Aspiration in Patients With Neurological Disorders

“…20 The EAT-10 was reported as a discriminative tool for identification of aspiration risk in 2 previous studies. 2,13,14 Our findings regarding high discriminant ability of the T-EAT-10 in detecting aspiration in neurological patients are similar to the findings of these studies. 2,13,14 Different criterion scores were used due to methodological differences in these studies.…”

“…The earlier investigation used a cut value of 8, and reported that this score correctly identified 85.7% of ALS aspirators with 71.9% specificity. 2 The cut score according to the mean EAT-10 of non-aspirators in the study of Cheney et al 13 was 16 as our cut score from our neurological patient population. Cheney et al 13 reported that the sensitivity of EAT-10 was 71.0%, the specificity was 53.0%, and the negative predictive value was 89.0%.…”

“…[7][8][9][10][11][12] There are 2 studies performed in the general patient population and 1 study in patients with amyotrophic lateral sclerosis (ALS) to show the ability of the EAT-10 to identify individuals who are at risk of aspiration. 2,13,14 Besides the approximately 85.0% of ALS patients suffer from dysphagia due to progressive weakness and/or spasticity in the muscles of oropharyngeal and esophageal regions, 2,15 8.1-80.0% of patients with stroke, 11.0-81.0% of patients with PD, and 33.0-43.0% of MS patients also encounter dysphagia. [1][2][3] Thus, this ability of the EAT-10 could be used in all neurological patient groups who are at risk of aspiration in clinical settings.…”

“…2,13,14 Besides the approximately 85.0% of ALS patients suffer from dysphagia due to progressive weakness and/or spasticity in the muscles of oropharyngeal and esophageal regions, 2,15 8.1-80.0% of patients with stroke, 11.0-81.0% of patients with PD, and 33.0-43.0% of MS patients also encounter dysphagia. [1][2][3] Thus, this ability of the EAT-10 could be used in all neurological patient groups who are at risk of aspiration in clinical settings. With this in mind, the results of the EAT-10 may be used as a direct instrument to perform further detailed evaluation of the swallowing function for clinicians.…”

“…[1][2][3] Dysphagia symptoms include impaired labial closure, difficulty in initiating swallowing, residue, choking/coughing during swallowing, and piecemeal deglutition, which allow caregivers and clinicians suspect from dysphagia. It is important to detect dysphagia symptoms in an early period because neurogenic dysphagia can result in dehydration, malnutrition, respiratory complications, and also reduce the quality of life of the patients and their families due to its psychosocial consequences if untreated.…”