Development of an Ultrasound-Based Score for Screening Swallowing Disorders: Diagnostic Accuracy and Cutoff Points.

OBJECTIVE

To determine whether specific ultrasound (US) measures and cutoff scores from a new point-based scoring system were able to confirm the findings of the videofluoroscopic swallow study (VFSS) in diagnosing swallowing disorders (SDs).

DESIGN

A cross-sectional, single-center study from March 2021 to March 2023. Initial SD screening on the Penetration Aspiration Scale and subsequent evaluation on the VFSS were administered to confirm SD. Additionally, a US study examined tongue thickness, tongue movement, hyoid bone displacement, and suprahyoid muscles. A scoring system based on these US measures was developed, and cutoff scores for the presence/absence of SDs were determined from the US and VFSS findings.

SETTING

A single tertiary referral center providing both ambulatory and inpatient care.

PARTICIPANTS

One hundred nineteen adults (N=119) consecutively admitted to the SDs unit with suspected SDs. Exclusion criteria included total laryngectomy, health conditions preventing standard evaluation (eg, dyspnea, musculoskeletal disorders), and prior evaluation in the unit.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: The SDs was able to be confirmed on the US-based score. The US cutoff scores were related to the presence or absence of SDs based on the findings of the VFSS.

RESULTS

The SDs diagnosed in 75 (63%) based on VFSS and corroborated with main US features seen during swallowing. The logistic model developed included tongue movement, hyoid bone displacement, geniohyoid thickness at rest, and sex (area under the curve=0.83; 95% CI, 0.75-0.91). The US scoring system developed ranges from 0 to 5, with 0 indicating no dysphagia and 3-5 indicating SDs. The optimal cutoff to rule out SDs was ˂1, with a negative likelihood ratio of 0.04 and a negative posttest probability of 6%. To rule in SDs, the optimal cutoff was ≥3, with a positive likelihood ratio of 5.1 and a positive posttest probability of 90%.

CONCLUSIONS

The US-based scoring system is a promising, easy-to-use assessment tool with good diagnostic accuracy and useful posttest probabilities for SDs assessment. Further research is needed before clinical adoption.