Eating Assessment Tool-10 Useful in Dysphagia Screening at Amyotrophic Lateral Sclerosis Clinics

by Linda Kossoff •

How effective is the validated Eating Assessment Tool-10 (EAT-10) in identifying functional impairments in swallowing efficiency and/or safety in patients with amyotrophic lateral sclerosis (ALS)?

BOTTOM LINE

The EAT-10 is an easy-to-administer dysphagia screening tool with good discriminant ability for use in ALS clinics.

BACKGROUND: Bulbar dysfunction leads to dysphagia in some 85% of patients with ALS, causing devastating, life-threatening effects. Early bulbar dysfunction detection requires ongoing monitoring of swallowing function in these individuals. Guidelines advocate use of a validated patient–report outcome (PRO), such as the EAT-10, for perceived swallowing safety and efficiency impairment.

STUDY DESIGN: Prospective, observational, longitudinal study.

SETTING: Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla.

SYNOPSIS: For the study, a total of 273 patients with a confirmed ALS diagnosis completed the EAT-10 and underwent a videofluoroscopic (VF) swallowing study. Duplicate, independent, blinded analyses of the validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale were performed to index swallowing safety and efficiency. Researchers’ between-groups analysis examining EAT-10 scores across dysphagia severity levels showed higher EAT-10 scores with increasing DIGEST levels. Mean EAT-10 scores were approximately three times higher in ALS individuals with confirmed dysphagia compared to those without. Of 263 VF exams, the EAT-10 correctly classified 202 exams with dysphagia. Of 93 VF exams with moderate or worse dysphagia, the EAT-10 correctly classified 75 cases. Although the EAT-10 demonstrated adequate sensitivity to detect impairments in swallowing safety and efficiency in people with ALS, 142 tests (32.6%) for detecting mild or worse dysphagia and 134 tests (30.8%) for detecting moderate or worse dysphagia were misclassified. The authors conclude that the EAT-10 could be included in dysphagia screening to identify and triage patients for further evaluation in busy ALS clinics. Study limitations included exclusion of potential demographic and geographic variables.

CITATION: Donohue C, Gray LT, Anderson A, et al. Discriminant ability of the Eating Assessment Tool-10 to detect swallowing safety and efficiency impairments. Laryngoscope. 2022;132:2319-2326.