Screening for Swallowing Problems in Patients Following Prolonged Intubation: Validation of the Toronto Bedside Swallowing Screening Test (TOR-BSST©)

Study Overview
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Brief Summary
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Despite medical advances, half of the patients admitted to hospital for recovery from acute illness, injury or surgery have swallowing difficulties and those requiring tubes for breathing support are at even greater risk. Difficulties with swallowing decrease patients' quality of life, prolong their hospital stay, as well as lead to medical complications such as pneumonia, malnutrition and death. Presently, there is no screening test for swallowing difficulties in patients who have required respiratory support. Screening will allow for early detection of swallowing problems which is important to prevent serious complications, such as pneumonia. This research will determine the accuracy of a new screening test, the Toronto Bedside Swallowing Screening Test (TOR-BSST©) previously tested with stroke patients, to predict the presence of swallowing difficulties in patients who have required breathing support for longer than 48 hours. The investigators will enroll 100 patients from the intensive care medical surgical units at the University Health Network. The findings from this research will help identify those patients with swallowing problems earlier than it is currently possible. Once identified, at risk patients will be referred to a speech language pathologist swallowing expert for more comprehensive testing; thereby, decreasing their risk of experiencing serious complications, such as pneumonia, secondary to swallowing problems.

Conditions
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Dysphagia

Intervention / Treatment
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* Other: Toronto Bedside Swallowing Screening Test (TOR-BSST©)
* Procedure: Videofluoroscopic Swallow Study


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults 18+ years Inpatient at University Health Network, in any of the medical-surgical intensive care units, regardless of disease type, comorbidities or previous medical history Received endotracheal intubation lasting 48 hours or longer Exclusion Criteria: History of one or more of the following: neurological disorder, surgery to the head or neck, previous oropharyngeal dysphagia, tracheotomy in situ or dementia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Med/Surg ICU Inpatients, Intubated ≥ 48 hours<br> | Other: Toronto Bedside Swallowing Screening Test (TOR-BSST©)<br>* All enrolled patients will be screened for dysphagia by two blinded screeners using the TOR-BSST©.<br>Procedure: Videofluoroscopic Swallow Study<br>* All enrolled patients will undergo a videofluoroscopic assessment of swallowing within 24 hours of being screened with the TOR-BSST©.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Validity of the TOR-BSST© | The validity of the TOR-BSST© will be measured using sensitivity, specificity, likelihood ratios, positive predictive value (PPV), and negative predictive value (NPV). Results of the videofluoroscopic assessment of swallowing will be used as the gold standard comparison. | 24 hours | 
| Inter-rater reliability of the TOR-BSST© | Inter-rater reliability will be calculated using the intraclass correlation coefficient (ICC). | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimation of the incidence of dysphagia in adult acute patients following prolonged intubation |  | 24 hours | 
| Description of the impairment characteristics of dysphagia in adult acute patients following prolonged intubation |  | 24 hours |