Prospective validation of the edinburgh dysphagia score in South-east London

ABSTRACT

IntroductionAlthough dysphagia should be considered a high-risk symptom for cancer referral pathways, the yield of endoscopy for cancer is currently <5%. Even prior to the COVID-19 pandemic, this was a significant burden for endoscopy units and subjected patients to inappropriate concern at being referred and investigated for suspected cancer. The BSG endorsed use of the Edinburgh Dysphagia Score (cut-off 3.5) to target endoscopy for those at highest risk,1 based on previously published results2.MethodsUse of the EDS was agreed as a service addition during the COVID-19 recovery period in SE London. All patients referred for dysphagia on the suspected cancer pathway in four acute Trusts were contacted either prior or on arrival in the endoscopy unit to complete the EDS, but the result did not alter the intended pathway (ie. all patients still completed endoscopy). Patients were then followed to final or working diagnosis as determined by the direct care team. As the EDS was primarily designed to prioritise for cancer diagnosis, this was the primary outcome measure. All other diagnoses were recorded and considered ‘significant’ if felt to be the cause of the patient’s presentation. Data on ethnicity was collected to ensure the reliability of the EDS in diverse patient groups found across SE London.Results240 patients (117F;mean age 55.7±14.7y;n=112 (46.7%) non-White British) completed their investigation pathway with 20 (8%) cancers diagnosed. 125 reported EDS <3.5 and none had upper GI cancer, while all 20 cancers occurred in the ESD>3.5 group (n=115;17.3%;median score 8(7-9)). Significant diagnoses were found in 35 patients (28%) with EDS<3.5 and 48 (41.7%) in the >3.5 group.ConclusionThe EDS cut-off of 3.5 had a 100% negative predictive value in this new prospective cohort and would have resulted in a more-than-doubling of ‘hit-rate’ for diagnosis of cancer. The rate of significant diagnoses in the <3.5 cohort emphasises that investigations are still required, but adoption of the EDS could be used to safely defer or divert patients, avoiding inappropriate use of suspected cancer pathways.ReferenceBr J Surg 2010;97(12)1831-7. www.bsg.org.uk