Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway

Umair Kamran; Dominic King; Matthew Banks; David  Nylander; Sharan  Shetty; Srisha Hebbar; Rupert  Ransford; David  Mitchell; Matthew  Williams; Sanjay  Gupta; Danny Cheung; Graham Baker; James Rees; Mark  Fox; Barbara  Ashall; Sophie  Barker; John  Greenaway; Miriam  Jones; Matthew  Caffrey; Sudarshan Kadri; Michael Glynn; Tony C  Tham; Nicola Adderley; Nigel Trudgill; James Evans

doi:10.1111/apt.16811

Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway

Umair Kamran, Dominic King, Matthew Banks, David Nylander, Sharan Shetty, Srisha Hebbar, Rupert Ransford, David Mitchell, Matthew Williams, Sanjay Gupta, Danny Cheung, Graham Baker, James Rees, Mark Fox, Barbara Ashall, Sophie Barker, John Greenaway, Miriam Jones, Matthew Caffrey, Sudarshan KadriMichael Glynn, Tony C Tham, Nicola Adderley, Nigel Trudgill, James Evans

Applied Health Research

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Abstract

Background
The British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase.

Aims
External validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance.

Methods
A prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed.

Results
1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51–73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7–99.3)% and an NPV of 99.3 (97.8–99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3–99.7)% and NPV of 99.5 (98.1–99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS.

Conclusions
In a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.

Original language	English
Journal	Alimentary Pharmacology & Therapeutics
Early online date	5 Mar 2022
DOIs	https://doi.org/10.1111/apt.16811
Publication status	E-pub ahead of print - 5 Mar 2022

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This is the peer reviewed version of the following article: (see citation), which has been published in final form at https://doi.org/10.1111/apt.16811. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
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Cite this

Kamran, U., King, D., Banks, M., Nylander, D., Shetty, S., Hebbar, S., Ransford, R., Mitchell, D., Williams, M., Gupta, S., Cheung, D., Baker, G., Rees, J., Fox, M., Ashall, B., Barker, S., Greenaway, J., Jones, M., Caffrey, M., ... Evans, J. (2022). Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway. Alimentary Pharmacology & Therapeutics. Advance online publication. https://doi.org/10.1111/apt.16811

@article{660a006335bf4d1b89e64bff6ad962a3,

title = "Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway",

abstract = "BackgroundThe British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase.AimsExternal validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance.MethodsA prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed.Results1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51–73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7–99.3)% and an NPV of 99.3 (97.8–99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3–99.7)% and NPV of 99.5 (98.1–99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS.ConclusionsIn a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.",

author = "Umair Kamran and Dominic King and Matthew Banks and David Nylander and Sharan Shetty and Srisha Hebbar and Rupert Ransford and David Mitchell and Matthew Williams and Sanjay Gupta and Danny Cheung and Graham Baker and James Rees and Mark Fox and Barbara Ashall and Sophie Barker and John Greenaway and Miriam Jones and Matthew Caffrey and Sudarshan Kadri and Michael Glynn and Tham, {Tony C} and Nicola Adderley and Nigel Trudgill and James Evans",

year = "2022",

month = mar,

day = "5",

doi = "10.1111/apt.16811",

language = "English",

journal = "Alimentary Pharmacology & Therapeutics",

issn = "0269-2813",

publisher = "Wiley",

}

Kamran, U, King, D, Banks, M, Nylander, D, Shetty, S, Hebbar, S, Ransford, R, Mitchell, D, Williams, M, Gupta, S, Cheung, D, Baker, G, Rees, J, Fox, M, Ashall, B, Barker, S, Greenaway, J, Jones, M, Caffrey, M, Kadri, S, Glynn, M, Tham, TC, Adderley, N, Trudgill, N & Evans, J 2022, 'Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway', Alimentary Pharmacology & Therapeutics. https://doi.org/10.1111/apt.16811

TY - JOUR

T1 - Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway

AU - Kamran, Umair

AU - King, Dominic

AU - Banks, Matthew

AU - Nylander, David

AU - Shetty, Sharan

AU - Hebbar, Srisha

AU - Ransford, Rupert

AU - Mitchell, David

AU - Williams, Matthew

AU - Gupta, Sanjay

AU - Cheung, Danny

AU - Baker, Graham

AU - Rees, James

AU - Fox, Mark

AU - Ashall, Barbara

AU - Barker, Sophie

AU - Greenaway, John

AU - Jones, Miriam

AU - Caffrey, Matthew

AU - Kadri, Sudarshan

AU - Glynn, Michael

AU - Tham, Tony C

AU - Adderley, Nicola

AU - Trudgill, Nigel

AU - Evans, James

PY - 2022/3/5

Y1 - 2022/3/5

N2 - BackgroundThe British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase.AimsExternal validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance.MethodsA prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed.Results1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51–73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7–99.3)% and an NPV of 99.3 (97.8–99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3–99.7)% and NPV of 99.5 (98.1–99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS.ConclusionsIn a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.

AB - BackgroundThe British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase.AimsExternal validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance.MethodsA prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed.Results1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51–73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7–99.3)% and an NPV of 99.3 (97.8–99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3–99.7)% and NPV of 99.5 (98.1–99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS.ConclusionsIn a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.

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U2 - 10.1111/apt.16811

DO - 10.1111/apt.16811

M3 - Article

SN - 0269-2813

JO - Alimentary Pharmacology & Therapeutics

JF - Alimentary Pharmacology & Therapeutics

ER -

Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway

Abstract

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