title: Validated swallowing and nutrition guidelines for patients with head and neck cancer: identification of high-risk patients for proactive gastrostomy.
abstract: BACKGROUND
  The "Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer" were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines.
  
  
  METHODS
  Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high-risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation.
  
  
  RESULTS
  Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High-risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%.
  
  
  CONCLUSIONS
  The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision-making on proactive gastrostomy tube insertion.
authors.affiliation: Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Teresa E
authors.initials: TE
authors.lastname: Brown
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Spurgin
authors.forename: Lynda
authors.initials: L
authors.lastname: Ross
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.forename: Jacqui
authors.initials: J
authors.lastname: Keller
authors.forename: Brett G M
authors.initials: BG
authors.lastname: Hughes
authors.forename: Rob
authors.initials: R
authors.lastname: Hodge
authors.forename: Quenten
authors.initials: Q
authors.lastname: Walker
authors.forename: Merrilyn
authors.initials: M
authors.lastname: Banks
authors.forename: Lizbeth Moira
authors.initials: LM
authors.lastname: Kenny
authors.forename: Jane
authors.initials: J
authors.lastname: Crombie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003657:Decision Making; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D019983:Guideline Adherence; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods / Q000592:standards*; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult