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Development of a Non-invasive Device for Swallow Screening in Patients at Risk of Oropharyngeal Dysphagia: Results from a Prospective Exploratory Study

Steele, Catriona M.; Mukherjee, Rajat; Kortelainen, Juha M.; Pölönen, Harri; Jedwab, Michael; Brady, Susan L.; Theimer, Kayla Brinkman; Langmore, Susan; Riquelme, Luis F.; Swigert, Nancy B.; Bath, Philip M.; Goldstein, Larry B.; Hughes, Richard L.; Leifer, Dana; Lees, Kennedy R.; Meretoja, Atte; Muehlemann, Natalia

Development of a Non-invasive Device for Swallow Screening in Patients at Risk of Oropharyngeal Dysphagia: Results from a Prospective Exploratory Study Thumbnail


Authors

Catriona M. Steele

Rajat Mukherjee

Juha M. Kortelainen

Harri Pölönen

Michael Jedwab

Susan L. Brady

Kayla Brinkman Theimer

Susan Langmore

Luis F. Riquelme

Nancy B. Swigert

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine

Larry B. Goldstein

Richard L. Hughes

Dana Leifer

Kennedy R. Lees

Atte Meretoja

Natalia Muehlemann



Abstract

Oropharyngeal dysphagia is prevalent in several at-risk populations, including post-stroke patients, patients in intensive care and the elderly. Dysphagia contributes to longer hospital stays and poor outcomes, including pneumonia. Early identification of dysphagia is recommended as part of the evaluation of at-risk patients, but available bedside screening tools perform inconsistently. In this study, we developed algorithms to detect swallowing impairment using a novel accelerometer-based dysphagia detection system (DDS). A sample of 344 individuals was enrolled across seven sites in the United States. Dual-axis accelerometry signals were collected prospectively with simultaneous videofluoroscopy (VFSS) during swallows of liquid barium stimuli in thin, mildly, moderately and extremely thick consistencies. Signal processing classifiers were trained using linear discriminant analysis and 10,000 random training–test data splits. The primary objective was to develop an algorithm to detect impaired swallowing safety with thin liquids with an area under receiver operating characteristic curve (AUC) > 80% compared to the VFSS reference standard. Impaired swallowing safety was identified in 7.2% of the thin liquid boluses collected. At least one unsafe thin liquid bolus was found in 19.7% of participants, but participants did not exhibit impaired safety consistently. The DDS classifier algorithms identified participants with impaired thin liquid swallowing safety with a mean AUC of 81.5%, (sensitivity 90.4%, specificity 60.0%). Thicker consistencies were effective for reducing the frequency of penetration–aspiration. This DDS reached targeted performance goals in detecting impaired swallowing safety with thin liquids. Simultaneous measures by DDS and VFSS, as performed here, will be used for future validation studies.

Journal Article Type Article
Acceptance Date Dec 29, 2018
Online Publication Date Jan 5, 2019
Publication Date Jan 5, 2019
Deposit Date May 7, 2019
Publicly Available Date May 7, 2019
Journal Dysphagia
Print ISSN 0179-051X
Electronic ISSN 1432-0460
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 34
Issue 5
Pages 698-707
DOI https://doi.org/10.1007/s00455-018-09974-5
Keywords Deglutition; Deglutition disorders; Dysphagia; Swallowing; Screening; Devices
Public URL https://nottingham-repository.worktribe.com/output/2026233
Publisher URL https://link.springer.com/article/10.1007/s00455-018-09974-5

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