Weighing up the pros and cons of dysphagia triage in South Africa.
Kelly-Ann Kater, Jaishika Seedat
PMID 36861903WHAT IT FOUND
A two-minute doctor triage checklist flagged 27 of 67 emergency patients as dysphagia risk, but it did not agree reliably with screening and flagged many patients without dysphagia.
Key findings
01Of 67 patients triaged, 27 failed the triage checklist, while the screening tool found dysphagia in 5.
02The checklist and screening tool gave the same pass or fail result for 59.7% of patients, but Cohen's kappa was 0.04, which the paper calls poor reliability.
03The checklist was described as highly sensitive, but false positives were problematic because patients failed triage when screening did not show dysphagia.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used one hospital emergency unit, and not all emergency departments at the site consented, so the results may not apply to other settings. Only 16 medical staff and 67 patients were involved, which is small for judging a triage tool. Doctors did not return the questionnaire, so face validity and staff acceptability were not assessed. The text and tables disagree on how many patients failed the screening tool, so the accuracy is hard to check. Some patients failed triage for reasons other than dysphagia, such as being on oxygen, so the checklist may over-refer. No qualitative feedback from emergency staff was collected, so barriers and facilitators to using the checklist are unknown.
Declared interests
No funding or conflict-of-interest declaration is included in the supplied text.
The easy way to misread this
Do not conclude that dysphagia triage is ready for use. The tested checklist was sensitive but had poor reliability and validity, and many patients without dysphagia were flagged, so it cannot yet decide who needs assessment.