Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis.
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
Seventy ALS patients completed the EAT-10 survey and underwent a standardized videofluoroscopic evaluation of swallowing. 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.


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
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.
Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.|Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA.
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http://orcid.org/0000-0002-0198-4297
EK
Plowman
Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.|Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA.
L C
LC
Tabor
Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.|Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA.
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R
Robison
Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, FL, USA.
J
J
Gaziano
Department of Policy and Services Research Data Center, University of South Florida, Tampa, FL, USA.
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C
Dion
Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, FL, USA.
S A
SA
Watts
Department of Neurology, University of South Florida, Tampa, FL, USA.
T
T
Vu
Department of Neurology, University of South Florida, Tampa, FL, USA.
C
C
Gooch
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000175:diagnosis*; D019540:Area Under Curve; D001466:Barium Sulfate; D003287:Contrast Media; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014741:Video Recording
D003287:Contrast Media; D001466:Barium Sulfate
EAT-10; Eating Assessment Tool; amyotrophic lateral sclerosis; aspiration; dysphagia; screen