I don’t know about you, but these days I can use all the help I can get for making my job easier, shorter, or sweeter😉. I mean, we can always improve either as clinicians or as a field, right? The Eating Assessment Tool-10 (EAT-10) has been around since 2008, and this recent article looks at ways to give it a bit of a future makeover! 🤓
Title: Diagnostic Accuracy of the Eating Assessment Tool‑10 (EAT‑10) in Screening Dysphagia: A Systematic Review and Meta‑Analysis
Authors: Zhang, Yuan, Lu, Li, Zhang, Wang, & Wang
Year of Publication: June 2022
Design Type: Systematic Review & Meta-Analysis
Inclusion criteria: age >18 yrs, clear consciousness, ability to understand/cooperate for questionnaire, screened EAT-10 with cutoff value of 2 or 3, diagnostic gold standard of FEES or VFSS, PAS>2, results can be used to directly/indirectly obtain true-positive, false-positive, true-negative, and false-negative rates
Exclusion criteria: conference papers, case reports, letters, reviews; significant missing data; authors who did not reply to contact; poor study quality (grade C); errors in statistical methods
“Although many studies have reported the diagnostic accuracy of EAT-10, there is still no consensus on the best cutoff value for the diagnosis of dysphagia.”
The article essentially tries to answer the question,
“Which cut-off score is best for predicting patients with swallowing disorders?“
“In this study, a meta-analysis of the most controversial values – 2 and 3 – was conducted to calculate their diagnostic performance and to determine the best cutoff value for EAT-10 in predicting patients with swallowing disorders.” p.7
Out of 955 related preliminary studies and after duplicates and further consensus…A total of 7 studies were deemed appropriate to include.
The meta-analysis included 1064 subjects across 7 countries and multiple populations including healthy people, Parkinson’s Disease, stroke, ALS, aging, neurodegenerative diseases, demyelinating diseases, and gastroesophageal reflux disease
Four studies used VFSS and 3 studies used FEES (all used a PAS>2 to define dysphagia in advance for reference)
2 out of the 7 studies were judged to be high quality and 5 were medium quality
“Sensitivity refers to the ability to screen out patients with illness or related symptoms and specificity is the ability to exclude patients without disease or related symptoms.” p.7
While a cutoff of 2 had a 4% higher sensitivity rating than that of 3, this impacted the specificity at the cost of greatly increasing the misdiagnosis rate with a specificity 23% lower compared to a cutoff of 3.
“This study shows that an EAT-10 cutoff value of 3 has a diagnostic accuracy better than a cutoff of 2”
“Using 2 and 3 as cutoff values showed good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, the diagnostic accuracy with a cutoff of 3 is higher, which can not only screen most high-risk groups of swallowing disorders but also avoid a high misdiagnosis rate. Therefore, a cutoff of 3 is recommended as the best cutoff value for EAT-10.” p.8, 11
Population specifics (for Sensitivity/Specificity)
- HNC: scores were significantly higher, with cut-off value at 15 for 81% sensitivity and 58% specificity
- Unilateral vocal fold paralysis: predicting aspiration with cut-off score of 9 for 77.8% sensitivity and 73.1% specificity
- ALS: 86% sensitivity and 76% specificity (likelihood ratio of 3.1)
- COPD: 91.67% sensitivity and 77.78% specificity (diagnostic ratio of 38.50)
- PD: only 58% sensitivity for predicting aspiration with a cut-off value of 6 (likely due to decreased laryngopharyngeal sensitivity, inability to notice post-swallow residue, and reduced cough reflex)
- PEDS: sensitivity of 91.3% and specificity of 98.8% with cut-off value of 9
Factors to consider that can impact results of the sensitivity/specificity:
- Cultural differences
- cognitive status
- False negatives instrumental swallow studies
- type of disease (particularly for PD)
- choice of instrumental swallow study (particularly for COPD+FEES)
Some more investigating on modifying (possible eliminating and/or changing question items) is still needed!
Looks like a cut off of “3” may be recommended to be more diagnostically accurate for selecting those with concerns for dysphagia. BUT–it can depend on the population as well as other factors.
Zhang, P., Yuan, Y., Lu, D., Li, T., Zhang, H., Wang, H., & Wang, X. (2022). Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia. doi: 10.1007/s00455-022-10486-6
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