Diagnostic validity of methods for assessment of swallowing sounds: a systematic review
Bibliographic record
Abstract
Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test. A disfagia orofaríngea é uma comorbidade altamente prevalente em pacientes neurológicos e representa uma séria ameaça à saúde, pode levar a desfechos como pneumonia por aspiração, hospitalização e até morte. A avaliação propõe um método não invasivo, acústico, para diferenciar entre indivíduos com e sem sinais de penetração e aspiração. Esta revisão sistemática analisou a validade diagnóstica de diferentes métodos para avaliação dos sons de deglutição, quando comparados com a videofluoroscopia da deglutição para detectar disfagia orofaríngea. Artigos nos quais o objetivo principal era avaliar a acurácia dos sons de deglutição foram pesquisados em cinco bancos de dados eletrônicos sem limitações de idioma ou tempo de publicação. As medidas de acurácia descritas nos estudos foram transformadas para construir curvas ROC (Receptor Operating Characteristic) e gráfico em floresta (forest plot) com o auxílio do software Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Dinamarca). A metodologia dos estudos selecionados foi avaliada com a ferramenta Avaliação da Qualidade de Estudos de Acurácia de Testes Diagnósticos-2. A busca eletrônica final resultou na identificação de 554 artigos; no entanto, apenas três estudos preencheram os critérios de inclusão. Os valores de acurácia (área abaixo da curva) foram 0,94 para microfone, 0,80 para doppler e 0,60 para estetoscópio. Baseado nas evidências limitadas e da baixa qualidade metodológica, pois foram poucos os estudos incluídos, e com pequeno tamanho amostral, de todos os testes diagnósticos (index testes) encontrados para essa revisão sistemática o doppler mostrou excelente acurácia diagnóstica na discriminação dos sons de deglutição, o microfone demonstrou uma boa acurácia na discriminação dos sons de pacientes disfágicos e o estetoscópio revelou o melhor teste de triagem.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.042 | 0.203 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.016 |
| Bibliometrics | 0.022 | 0.017 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".