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Open Access 18-07-2022 | Dysphagia | Review

Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis

Authors: Ping-ping Zhang, Ying Yuan, De-zhi Lu, Ting-ting Li, Hui Zhang, Hong-ying Wang, Xiao-wen Wang

Published in: Dysphagia | Issue 1/2023

Abstract

The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82–0.93), 0.59 (95% CI 0.39–0.77), 2.17 (95% CI 1.38–3.42), 0.19 (95% CI 0.13–0.29), and 11.49 (95% CI 5.86–22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68–0.94), 0.82 (95% CI 0.65–0.92), 4.84 (95% CI 1.72–13.50), 0.18 (95% CI 0.07–0.46), and 26.24 (95% CI 5.06–135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82–0.93) and 0.903 (95% CI 0.88–0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.

Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455–78. https://doi.org/10.1016/s0016-5085(99)70144-7.CrossRef

Triggs J, Pandolfino J. Recent advances in dysphagia management. F1000Research. 2019. https://doi.org/10.12688/f1000research.18900.1.CrossRef

Estupiñán Artiles C, Regan J, Donnellan C. Dysphagia screening in residential care settings: a scoping review. Int J Nurs Stud. 2021;114:103813. https://doi.org/10.1016/j.ijnurstu.2020.103813.CrossRef

Clavé P, Rofes L, Carrión S, Ortega O, Cabré M, Serra-Prat M, Arreola V. Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Nestle Nutr Inst Workshop Ser. 2012;72:57–66. https://doi.org/10.1159/000339986.CrossRef

Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70. https://doi.org/10.1038/nrgastro.2015.49.CrossRef

Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98. https://doi.org/10.2147/cia.S23404.CrossRef

Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10(5):380–6. https://doi.org/10.1159/000016094.CrossRef

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63. https://doi.org/10.1161/01.STR.0000190056.76543.eb.CrossRef

Ebihara S, Sekiya H, Miyagi M, Ebihara T, Okazaki T. Dysphagia, dystussia, and aspiration pneumonia in elderly people. J Thorac Dis. 2016;8(3):632–9. https://doi.org/10.21037/jtd.2016.02.60.CrossRef

10.

Kalf JG, de Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–5. https://doi.org/10.1016/j.parkreldis.2011.11.006.CrossRef

11.

Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24. https://doi.org/10.1177/000348940811701210.CrossRef

12.

Chu LW, Pei CK. Risk factors for early emergency hospital readmission in elderly medical patients. Gerontology. 1999;45(4):220–6. https://doi.org/10.1159/000022091.CrossRef

13.

Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–9. https://doi.org/10.1001/archoto.2010.129.CrossRef

14.

Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L, Tyrrell PJ, Wolfe CD, Rudd AG. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry. 2017;88(1):25–30. https://doi.org/10.1136/jnnp-2016-313356.CrossRef

15.

Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29(5):545–52. https://doi.org/10.1007/s00455-014-9543-8.CrossRef

16.

Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders—European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–28. https://doi.org/10.2147/cia.S107750.CrossRef

17.

Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A. Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia. Acta Otorhinolaryngol Ital. 2016;36(5):395–402. https://doi.org/10.14639/0392-100x-829.CrossRef

18.

Moro L, Cazzani C. Dynamic swallowing study and radiation dose to patients. Radiol Med. 2006;111(1):123–9. https://doi.org/10.1007/s11547-006-0013-8.CrossRef

19.

McLean D, Smart R, Collins L, Varas J. Thyroid dose measurements for staff involved in modified barium swallow exams. Health Phys. 2006;90(1):38–41. https://doi.org/10.1097/01.hp.0000174812.97049.0e.CrossRef

20.

Hayes A, Alspaugh JM, Bartelt D, Campion MB, Eng J, Gayler BW, Henkel SE, Jones B, Lingaraj A, Mahesh M, Rostkowski M, Smith CP, Haynos J. Radiation safety for the speech-language pathologist. Dysphagia. 2009;24(3):274–9. https://doi.org/10.1007/s00455-008-9201-0.CrossRef

21.

Wright RE, Boyd CS, Workman A. Radiation doses to patients during pharyngeal videofluoroscopy. Dysphagia. 1998;13(2):113–5. https://doi.org/10.1007/pl00009554.CrossRef

22.

Chan CB, Chan LK, Lam HS. Scattered radiation level during videofluoroscopy for swallowing study. Clin Radiol. 2002;57(7):614–6. https://doi.org/10.1053/crad.2001.0904.CrossRef

23.

Weir KA, McMahon SM, Long G, Bunch JA, Pandeya N, Coakley KS, Chang AB. Radiation doses to children during modified barium swallow studies. Pediatr Radiol. 2007;37(3):283–90. https://doi.org/10.1007/s00247-006-0397-6.CrossRef

24.

Zammit-Maempel I, Chapple CL, Leslie P. Radiation dose in videofluoroscopic swallow studies. Dysphagia. 2007;22(1):13–5. https://doi.org/10.1007/s00455-006-9031-x.CrossRef

25.

Chau KH, Kung CM. Patient dose during videofluoroscopy swallowing studies in a Hong Kong public hospital. Dysphagia. 2009;24(4):387–90. https://doi.org/10.1007/s00455-009-9214-3.CrossRef

26.

Crawley MT, Savage P, Oakley F. Patient and operator dose during fluoroscopic examination of swallow mechanism. Br J Radiol. 2004;77(920):654–6. https://doi.org/10.1259/bjr/22832251.CrossRef

27.

Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769–85. https://doi.org/10.1016/j.pmr.2008.06.004.CrossRef

28.

Bonilha HS, Humphries K, Blair J, Hill EG, McGrattan K, Carnes B, Huda W, Martin-Harris B. Radiation exposure time during MBSS: influence of swallowing impairment severity, medical diagnosis, clinician experience, and standardized protocol use. Dysphagia. 2013;28(1):77–85. https://doi.org/10.1007/s00455-012-9415-z.CrossRef

29.

Madden C, Fenton J, Hughes J, Timon C. Comparison between videofluoroscopy and milk-swallow endoscopy in the assessment of swallowing function. Clin Otolaryngol Allied Sci. 2000;25(6):504–6. https://doi.org/10.1046/j.1365-2273.2000.00385.x.CrossRef

30.

Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke. 2005;36(9):1972–6. https://doi.org/10.1161/01.STR.0000177529.86868.8d.CrossRef

31.

Magalhães Junior HV, Pernambuco LA, Lima KC, Ferreira MAF. Screening for oropharyngeal dysphagia in older adults: a systematic review of self-reported questionnaires. Gerodontology. 2018. https://doi.org/10.1111/ger.12333.CrossRef

32.

Yu L, Wang J, Wang MH, Zhang DY, Yang W, Lei S. Research progress on dysphagia screening scale for the aged. Chin J Mod Nurs. 2020;26(6):711–6. https://doi.org/10.3760/cma.j.issn.1674-2907.2020.06.003.CrossRef

33.

Li H, Feng H, Chen HJ, Wang RM. Application progress of dysphagia screening tool in elderly care services. Chin J Rehabil Med. 2020;35(3):356–60. https://doi.org/10.3969/j.issn.1001-1242.2020.03.022.CrossRef

34.

Rumi W, Xuehong X, Changjie Z, Yongmei F. Reliability and validity of the Chinese Eating Assessment Tool (EAT-10) in evaluation of acute stroke patients with dysphagia. J Cent South Univ. 2015;40(12):1391–9. https://doi.org/10.11817/j.issn.1672-7347.2015.12.017.CrossRef

35.

Burgos R, Sarto B, Segurola H, Romagosa A, Puiggrós C, Vázquez C, Cárdenas G, Barcons N, Araujo K, Pérez-Portabella C. Translation and validation of the Spanish version of the EAT-10 (Eating Assessment Tool-10) for the screening of dysphagia. Nutr Hosp. 2012;27(6):2048–54. https://doi.org/10.3305/nh.2012.27.6.6100.CrossRef

36.

Möller R, Safa S, Östberg P. Validation of the Swedish translation of eating assessment tool (S-EAT-10). Acta Otolaryngol. 2016;136(7):749–53. https://doi.org/10.3109/00016489.2016.1146411.CrossRef

37.

Schindler A, Mozzanica F, Monzani A, Ceriani E, Atac M, Jukic-Peladic N, Venturini C, Orlandoni P. Reliability and validity of the Italian Eating Assessment Tool. Ann Otol Rhinol Laryngol. 2013;122(11):717–24. https://doi.org/10.1177/000348941312201109.CrossRef

38.

Gonçalves MI, Remaili CB, Behlau M. Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool—EAT-10. Codas. 2013;25(6):601–4. https://doi.org/10.1590/s2317-17822013.05000012.CrossRef

39.

Nogueira DS, Ferreira PL, Reis EA, Lopes IS. Measuring outcomes for dysphagia: validity and reliability of the European Portuguese eating Assessment Tool (P-EAT-10). Dysphagia. 2015;30(5):511–20. https://doi.org/10.1007/s00455-015-9630-5.CrossRef

40.

Shapira-Galitz Y, Yousovich R, Halperin D, Wolf M, Lahav Y, Drendel M. Does the Hebrew Eating Assessment Tool-10 correlate with pharyngeal residue, penetration and aspiration on fiberoptic endoscopic examination of swallowing? Dysphagia. 2019;34(3):372–81. https://doi.org/10.1007/s00455-018-9964-x.CrossRef

41.

Printza A, Kyrgidis A, Pavlidou E, Triaridis S, Constantinidis J. Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer-related oropharyngeal dysphagia. Eur Arch Otorhinolaryngol. 2018;275(7):1861–8. https://doi.org/10.1007/s00405-018-5001-9.CrossRef

42.

Lechien JR, Cavelier G, Thill MP, Huet K, Harmegnies B, Bousard L, Blecic S, Vanderwegen J, Rodriguez A, Dequanter D. Validity and reliability of the French version of Eating Assessment Tool (EAT-10). Eur Arch Otorhinolaryngol. 2019;276(6):1727–36. https://doi.org/10.1007/s00405-019-05429-1.CrossRef

43.

Abu-Ghanem S, Schechter M, Flesh-Eyni H, Litwin L, Makai E, Oestreicher-Kedem Y, Yehuda M. Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10). Folia Phoniatr Logop. 2016;68(6):261–7. https://doi.org/10.1159/000484557.CrossRef

44.

Giraldo-Cadavid LF, Gutiérrez-Achury AM, Ruales-Suárez K, Rengifo-Varona ML, Barros C, Posada A, Romero C, Galvis AM. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A blinded prospective cohort study. Dysphagia. 2016;31(3):398–406. https://doi.org/10.1007/s00455-016-9690-1.CrossRef

45.

Demir N, Serel Arslan S, İnal Ö, Karaduman AA. Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31(5):644–9. https://doi.org/10.1007/s00455-016-9723-9.CrossRef

46.

Serel Arslan S, Demir N, Karaduman AA, Belafsky PC. The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children. Disabil Rehabil. 2018;40(17):2088–92. https://doi.org/10.1080/09638288.2017.1323235.CrossRef

47.

Järvenpää P, Kuuskoski J, Pietarinen P, Markkanen-Leppänen M, Freiberg H, Ruuskanen M, Rekola J, Ilmarinen T, Kinnari TJ, Autio TJ, Penttilä E, Muttilainen MS, Laaksonen A, Oksanen L, Geneid A, Aaltonen LM. Finnish version of the Eating Assessment Tool (F-EAT-10): a valid and reliable patient-reported outcome measure for dysphagia evaluation. Dysphagia. 2021. https://doi.org/10.1007/s00455-021-10362-9.CrossRef

48.

Cheney DM, Siddiqui MT, Litts JK, Kuhn MA, Belafsky PC. The ability of the 10-Item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol. 2015;124(5):351–4. https://doi.org/10.1177/0003489414558107.CrossRef

49.

Rofes L, Arreola V, Mukherjee R, Clavé P. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):1256–65. https://doi.org/10.1111/nmo.12382.CrossRef

50.

Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31. https://doi.org/10.1186/1471-2288-6-31.CrossRef

51.

Schmidt L, Shokraneh F, Steinhausen K, Adams CE. Introducing RAPTOR: RevMan parsing tool for reviewers. Syst Rev. 2019;8(1):151. https://doi.org/10.1186/s13643-019-1070-0.CrossRef

52.

Schlickewei O, Nienstedt JC, Frank U, Fründt O, Pötter-Nerger M, Gerloff C, Buhmann C, Müller F, Lezius S, Koseki JC, Pflug C. The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson’s disease. Eur Arch Otorhinolaryngol. 2021;278(5):1661–8. https://doi.org/10.1007/s00405-020-06377-x.CrossRef

53.

Plowman EK, Tabor LC, Robison R, Gaziano J, Dion C, Watts SA, Vu T, Gooch C. Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil. 2016;28(1):85–90. https://doi.org/10.1111/nmo.12700.CrossRef

54.

Reitsma JB, Moons KG, Bossuyt PM, Linnet K. Systematic reviews of studies quantifying the accuracy of diagnostic tests and markers. Clin Chem. 2012;58(11):1534–45. https://doi.org/10.1373/clinchem.2012.182568.CrossRef

55.

Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46. https://doi.org/10.1007/s00455-001-0113-5.CrossRef

56.

Arslan SS, Demir N, Kılınç HE, Karaduman AA. The Ability of the Eating Assessment Tool-10 to detect aspiration in patients with neurological disorders. J Neurogastroenterol Motil. 2017;23(4):550–4. https://doi.org/10.5056/jnm16165.CrossRef

57.

Zuniga SA, Ebersole B, Jamal N. Utility of Eating Assessment Tool-10 in predicting aspiration in patients with unilateral vocal fold paralysis. Otolaryngol Head Neck Surg. 2018;159(1):92–6. https://doi.org/10.1177/0194599818762328.CrossRef

58.

Regan J, Lawson S, De Aguiar V. The Eating Assessment Tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia. 2017;32(5):714–20. https://doi.org/10.1007/s00455-017-9822-2.CrossRef

59.

Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T, Adler CH, Shill HA, Caviness JN, Samanta JE, Sue LI, Beach TG. Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol. 2013;72(7):614–23. https://doi.org/10.1097/NEN.0b013e3182965886.CrossRef

60.

Troche MS, Brandimore AE, Okun MS, Davenport PW, Hegland KW. Decreased cough sensitivity and aspiration in Parkinson disease. Chest. 2014;146(5):1294–9. https://doi.org/10.1378/chest.14-0066.CrossRef

61.

Jang DH, Choi KH, Kim DH, Lim CM, Kim JS. Comparison between the radionuclide salivagram and videofluoroscopic swallowing study methods for evaluating patients with aspiration pneumonia. Ann Nucl Med. 2013;27(3):247–52. https://doi.org/10.1007/s12149-012-0680-6.CrossRef

62.

Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723–7. https://doi.org/10.1097/MLG.0b013e318123ee6a.CrossRef

63.

Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17(4):308–15. https://doi.org/10.1007/s00455-002-0073-4.CrossRef

64.

Cordier R, Joosten A, Clavé P, Schindler A, Bülow M, Demir N, Arslan SS, Speyer R. Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis. Dysphagia. 2017;32(2):250–60. https://doi.org/10.1007/s00455-016-9754-2.CrossRef

Title: Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis
Authors: Ping-ping Zhang
Ying Yuan
De-zhi Lu
Ting-ting Li
Hui Zhang
Hong-ying Wang
Xiao-wen Wang
Publication date: 18-07-2022
Publisher: Springer US
Keywords: Dysphagia
Dysphagia
Dysphagia
Flexible Endoscopic Evaluation of Swallowing
Flexible Endoscopic Evaluation of Swallowing
Published in: Dysphagia / Issue 1/2023
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-022-10486-6

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Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis

Abstract

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