Validade diagnóstica dos métodos de avaliação dos sons de deglutição: uma revisão sistemática

Taveira, Karinna Veríssimo Meira; Santos, Rosane Sampaio; Leão, Bianca Lopes Cavalcante de; Stechman Neto, José; Pernambuco, Leandro; Silva, Letícia Korb da; Canto, Graziela De Luca; Porporatti, André Luís

doi:10.1016/j.bjorl.2017.12.008

Karinna Veríssimo Meira Taveira ^** Autor para correspondência. E-mail:karinnavm@hotmail.com, karinna@cb.ufrn.br (K.V. Taveira).

Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Morfologia, Centro de Biociências, Natal, RN, Brasil

Rosane Sampaio Santos

Universidade Tuiuti do Paraná (UTP), Programa de Pós-Graduação em Distúrbios da Comunicação, Curitiba, PR, Brasil

Bianca Lopes Cavalcante de Leão

Universidade Tuiuti do Paraná (UTP), Departamento de Odontologia, Curitiba, PR, Brasil

José Stechman Neto

Universidade Tuiuti do Paraná (UTP), Programa de Pós-Graduação em Distúrbios da Comunicação, Curitiba, PR, Brasil

Leandro Pernambuco

Universidade Federal da Paraíba (UFPB), Departamento de Fonoaudiologia, João Pessoa, PB, Brasil

Letícia Korb da Silva

Instituto de Educação Luterana de Santa Catarina, Departamento de Fonoaudiologia, Joinville, SC, Brasil

Graziela De Luca Canto

Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brasil

University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Alberta, Canada

André Luís Porporatti

Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brasil

* Autor para correspondência. E-mail:karinnavm@hotmail.com, karinna@cb.ufrn.br (K.V. Taveira).

Conflitos de interesse

Os autores declaram não haver conflitos de interesse.

Figuras (4)
Tabelas (10)

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Figura 1
Diagrama de fluxo dos critérios de busca na literatura e seleção.¹1 Logemann JA. Evaluation and treatment of swallowing disorders. Nat Student Speech Lang Hear Assoc J. 1984;:38-50.

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Figura 2
Resultados do Quadas-2 - Avaliação da Qualidade de Estudos de Acurácia de Testes Diagnósticos-2 (A, gráfico de risco de viés, B, resumo do risco de viés).

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Figura 3
Gráfico em floresta acoplado da sensibilidade e especificidade em estudos comparados de videofluoroscopia da deglutição e sons da deglutição (n = 3).

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Figura 4
Curvas ROC de sensibilidade e especificidade em estudos comparados de videofluoroscopia da deglutição e sons da deglutição.

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Database Search (October 8th 2016; updated on January 25th, 2017) Cochrane "deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow" in Title, Abstract, Keywords and videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies in Title, Abstract, Keywords and ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone in Title, Abstract, Keywords in Trials' LILACS (tw:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow")) AND (tw:(videofluoroscopy OR "videofluoroscopy swallowing study" OR vfss OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)) AND (tw:(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) PubMed ("deglutition"[MeSH Terms] OR "deglutition"[All Fields] OR "deglutitions"[All Fields] OR "swallowing"[All Fields] OR "swallowings"[All Fields] OR "swallows"[MeSH Terms] OR "swallows"[All Fields] OR "swallow"[All Fields]) AND (videofluoroscopy[All Fields] OR "videofluoroscopy swallowing study"[All Fields] OR VFSS OR "videofluoroscopy study"[All Fields] OR "swallowing videofluoroscopy"[All Fields] OR videofluoroscopic[All Fields] OR "videofluoroscopic swallowing"[All Fields] OR "videofluoroscopic swallowing study"[All Fields] OR fluoroscopy[MeSH Terms] OR fluoroscopy[All Fields] OR fluoroscopies) AND (ultrasonography[Subheading] OR ultrasonography[All Fields] OR ultrasound[All Fields] OR ultrasonography[MeSH Terms] OR ultrasound[All Fields] OR ultrasonics[MeSH Terms] OR ultrasonics[Text Word] OR ultrasonics[All Fields] OR "duplex doppler ultrasonography"[All Fields] OR "doppler duplex ultrasonography"[All Fields] OR "acoustic analysis"[All Fields] OR "acoustical analysis"[All Fields] OR auscultation[MeSH Terms] OR auscultation[All Fields] OR "cervical auscultation"[All Fields] OR accelerometry[MeSH Terms] OR accelerometry[All Fields] OR "swallowing accelerometry signals"[All Fields] OR "swallowing sounds"[All Fields] OR "swallow sounds"[All Fields] OR "signal processing"[All Fields] OR acoustics[MeSH Terms] OR acoustics[All Fields] OR acoustic[All Fields] OR "doppler effect"[MeSH Terms] OR doppler effect[Text Word] OR "doppler effect"[All Fields] OR "doppler shift" OR "shift, doppler" OR "effect, doppler" OR "sonar doppler"[All Fields] OR microphone[All Fields]) Scopus (TITLE-ABS-KEY("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") AND TITLE-ABS-KEY(videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies) AND TITLE-ABS-KEY(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) Web of Science Tópico:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") ANDTópico: (videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)AND Tópico: (ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) Google Scholar "deglutition OR swallowing:videofluoroscopy" Open Grey Swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis" ProQuest Swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"

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Test indicators Data analysis References DOR The value of a DOR ranges from 0 to infinity, with higher values indicating better discriminatory test performance. A value of 1 means that a test does not discriminate between patients with the disorder and those without it. Values lower than 1 point to improper test interpretation (more negative tests among the diseased). Glas et al.37 LRs >1 - diagnostic of interest McGee25 0 and 1 - against the diagnosis of interest 0 - less likely the disease =1 - lack diagnostic valeu Sensitivity 80% excellent, 70-80% good, 60-69% fair, <60% poor No consensus in this regard exists in the literature. Specificity 90% excellent, 80-90% good, 70-79% fair, <70% poor No consensus in this regard exists in the literature. Youden's Index Youden's Index values close to 1 indicate high accuracy; a value of zero is equivalent to uninformed guessing and indicates that a test has no diagnostic value. Deeks et al.38

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Author, year Reason for exclusion Dudik et al., 201639 3 Dudik et al., 201540 3 Dudik et al., 201641 3 Frakking et al., 201642 3 Frakking et al., 201643 3 Golabbakhsh et al., 201444 3 Lee et al., 200645 3 Mérey et al., 201246 3 Morinière et al., 201147 3 Movahedi et al., 201648 3 Nikjoo et al., 201132 3 Reddy et al., 200049 3 Sejdic et al., 201450 3 Seidic et al., 201351 3 Selley et al., 199452 3 Spadotto et al., 200953 3 Spadotto et al., 200854 3 Steele et al., 201355 3 Stroud et al., 200256 3 Tanaka et al., 201257 3 Zoratto et al., 201058 3 Lazareck et al., 200459 3 Exclusion criteria: (1) studies in animals; (2) studies that did not performed ultrasound, acoustic analysis, cervical auscultation, swallowing accelerometry signals and doppler effect; (3) studies that do not compare methods of diagnosis of swallowing for both control and dysphagic group with the reference standard (videofluoroscopy); (4) studies that do not present validity measurements (sensitivity and specificity) or did not present data enough to calculate them; (5) reviews, letters, conference, abstract, personal opinions.

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Item Abdulmassih et al., 201318 Jayatilake et al., 201519 Leslie et al., 200420 Domain 1: Patient selection Was a consecutive or random sample of patients enrolled? N N N Was a case-control design avoided? N N N Did the study avoid inappropriate exclusions? Y Y Y Could the selection of patients have introduced bias? H H H Concerns regarding applicability: Are there concern that the included patients and settings do not match the review question? L L L Domain 2: Index test Were the index test results interpreted without knowledge of the results of the reference standard? U U U If a threshold was used, was it prespecified? Y Y Y Could the conduct or interpretation of the index test have introduced bias? U U L Concerns regarding applicability: Are there concerns that the index test, its conduct, or its interpretation differ from the review question? L L L Domain 3: Reference standard Is the reference standard likely to correctly classify the target condition? Y Y Y Were the reference standard results interpreted without knowledge of the results of the index test? U U U Could the reference standard, its conduct, or its interpretation have introduced bias? L L L Concerns regarding applicability: Are there concerns that the target condition as defined by the reference standard does not match the question? L L L Domain 4: Flow and timing Was there an appropriate interval between index test(s) and reference standard? Y Y Y Did all patients receive the same reference standard? Y Y Y Were all patients included in the analysis? Y N N Could the patient flow have introduced bias? L L L Y, yes; N, no; U, unclear; Risk: L, low; H, high; U, unclear.

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Tabela 1
Resumo das características descritivas e desfechos de interesse dos estudos incluídos (n = 3)

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Tabela 2
Dados de validade do teste diagnóstico (n = 3)

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Banco de dados Pesquisa (8 de outubro de 2016; atualizada em 25 de janeiro de 2017) Cochrane "deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow" in Title, Abstract, Keywords and videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies in Title, Abstract, Keywords and ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone in Title, Abstract, Keywords in Trials' Lilacs (tw:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow")) AND (tw:(videofluoroscopy OR "videofluoroscopy swallowing study" OR vfss OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)) AND (tw:(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) PubMed ("deglutition"[MeSH Terms] OR "deglutition"[All Fields] OR "deglutitions"[All Fields] OR "swallowing"[All Fields] OR "swallowings"[All Fields] OR "swallows"[MeSH Terms] OR "swallows"[All Fields] OR "swallow"[All Fields]) AND (videofluoroscopy[All Fields] OR "videofluoroscopy swallowing study"[All Fields] OR VFSS OR "videofluoroscopy study"[All Fields] OR "swallowing videofluoroscopy"[All Fields] OR videofluoroscopic[All Fields] OR "videofluoroscopic swallowing"[All Fields] OR "videofluoroscopic swallowing study"[All Fields] OR fluoroscopy[MeSH Terms] OR fluoroscopy[All Fields] OR fluoroscopies) AND (ultrasonography[Subheading] OR ultrasonography[All Fields] OR ultrasound[All Fields] OR ultrasonography[MeSH Terms] OR ultrasound[All Fields] OR ultrasonics[MeSH Terms] OR ultrasonics[Text Word] OR ultrasonics[All Fields] OR "duplex doppler ultrasonography"[All Fields] OR "doppler duplex ultrasonography"[All Fields] OR "acoustic analysis"[All Fields] OR "acoustical analysis"[All Fields] OR auscultation[MeSH Terms] OR auscultation[All Fields] OR "cervical auscultation"[All Fields] OR accelerometry[MeSH Terms] OR accelerometry[All Fields] OR "swallowing accelerometry signals"[All Fields] OR "swallowing sounds"[All Fields] OR "swallow sounds"[All Fields] OR "signal processing"[All Fields] OR acoustics[MeSH Terms] OR acoustics[All Fields] OR acoustic[All Fields] OR "doppler effect"[MeSH Terms] OR doppler effect[Text Word] OR "doppler effect"[All Fields] OR "doppler shift" OR "shift, doppler" OR "effect, doppler" OR "sonar doppler"[All Fields] OR microphone[All Fields]) Scopus (TITLE-ABS-KEY("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") AND TITLE-ABS-KEY(videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies) AND TITLE-ABS-KEY(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) Web of Science Tópico:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") ANDTópico: (videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)AND Tópico: (ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone)) Google Scholar "deglutition OR swallowing:videofluoroscopy" Open Grey swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis" ProQuest swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"

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Indicadores de teste Análise de dados Referências DOR O valor de um ORD varia de 0 a infinito, com valores maiores indicando melhor desempenho do teste discriminatório. Um valor de 1 significa que um teste não discrimina entre pacientes com o distúrbio e pacientes sem o distúrbio. Valores inferiores a 1 ponto significam interpretação inadequada do teste (mais testes negativos entre os pacientes). Glas et al.37 RV > 1 - diagnóstico de interesse McGee25 0 e 1 - contra o diagnóstico de interesse 0 - menos provável a doença = 1 - falta de valor diagnóstico Sensibilidade 80% excelente, 70% -80% bom, 60% -69% razoável, < 60% ruim Não existe consenso na literatura a este respeito Especificidade 90% excelente, 80% -90% bom, 70% -79% razoável, < 70% ruim Não existe consenso na literatura a este respeito Índice de Youden Os valores do Índice de Youden próximos a 1 indicam alta acurácia; o valor igual a zero equivale a uma estimativa sem informações e indica que um teste não tem valor diagnóstico. Deeks et al.38

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Autor, Ano Razão para exclusão Dudik et al., 201639 3 Dudik et al., 201540 3 Dudik et al., 201641 3 Frakking et al., 201642 3 Frakking et al., 201643 3 Golabbakhsh et al., 201444 3 Lee et al., 200645 3 Mérey et al., 201246 3 Morinière et al., 201147 3 Movahedi et al., 201648 3 Nikjoo et al., 201132 3 Reddy et al., 200049 3 Sejdic et al., 201450 3 Seidic et al., 201351 3 Selley et al., 199452 3 Spadotto et al., 200953 3 Spadotto et al., 200854 3 Steele et al., 201355 3 Stroud et al., 200256 3 Tanaka et al., 201257 3 Zoratto et al., 201058 3 Lazareck et al., 200459 3 Critérios de exclusão: (1) Estudos com animais; (2) Estudos que não fizeram ultrassonografia, análise acústica, ausculta cervical, sinais de acelerometria para análise da deglutição ou efeito Doppler; (3) Estudos que não compararam métodos de diagnóstico da deglutição para ambos os grupos controle e disfágico com o padrão de referência (videofluoroscopia); (4) Estudos que não apresentaram medidas de validade (sensibilidade e especificidade) ou não apresentaram dados suficientes para calculá-los; 5) Revisões, cartas, conferências, resumo, opiniões pessoais.

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Item Abdulmassih et al., 201318 Jayatilake et al., 201519 Leslie et al., 200420 Domínio 1:Seleção de paciente Foi uma amostra consecutiva ou aleatória de pacientes incluídos? N N N Um desenho de caso-controle foi evitado? N N N O estudo evitou exclusões inadequadas? S S S A seleção de pacientes pode ter introduzido viés? A A A Questões relativas à aplicabilidade: Existe a preocupação de que os pacientes e as configurações incluídas não correspondem à questão da revisão? B B B Domínio 2:Teste diagnóstico (Index Test) Os resultados do teste diagnóstico (index test) foram interpretados sem o conhecimento dos resultados do padrão de referência? I I I Se um limiar foi usado, ele foi pré-especificado? S S S A condução ou a interpretação do teste diagnóstico (index test) podem ter introduzido um viés? I I B Questões relativas à aplicabilidade: Há preocupações de que o teste diagnóstico (index test), a sua condução ou interpretação diferem da questão da revisão? B B B Domínio 3:Padrão de referência O padrão de referência provavelmente classificará corretamente a condição-alvo? S S S Os resultados do padrão de referência foram interpretados sem o conhecimento dos resultados do teste diagnóstico (index test)? I I I O padrão de referência, a sua condução ou interpretação podem ter introduzido viés? B B B Questões relativas à aplicabilidade: Há preocupações de que a condição-alvo, conforme definido pelo padrão de referência, não coincida com a questão? B B B Domínio 4:Fluxo e tempo Existe um intervalo apropriado entre o(s) teste(s) diagnóstico(s) (index tests) e o padrão de referência? S S S Todos os pacientes receberam o mesmo padrão de referência? S S S Todos os pacientes foram incluídos na análise? S N N O fluxo de pacientes pode ter introduzido o viés? B B B N, não; PI, incerto; Risco: B, baixo; A, alto; I, incerto; S, sim.

Autor, ano, país	Faixa etária média (anos)	Tamanho da amostra nº de pacientes	Tamanho da amostra nº de observações	Teste diagnóstico (index test)	Teste de referência	Descrição	Desfecho	Conclusão
Abdulmassih et al., 2013, Brasil¹⁸18 David MAL, Alessandro L, Jennifer T, Douglas GA. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;7:1-6.	46,4 (28-62) saudáveis	30 saudáveis	30 saudáveis	Doppler	VFD Material de deglutição: líquido, 70 mL água e 30 mL de sulfato de bário 100%; pudim, 70 mL de água, 30 mL de sulfato de bário; sólidos, biscoitos "clube social" embebidos em bário	Análise acústica da deglutição	A prevalência na avaliação dinâmica da deglutição na VFD foi feita por alterações na fase oral de deglutição. A análise de variância das médias encontradas em cada variável - frequência, intensidade e duração da deglutição - mostra que houve correlação significativa quando comparada à curva de um indivíduo saudável.	Em pacientes com AEC, a média da frequência inicial, intensidade inicial e a intensidade final foram maiores e o tempo e a frequência de pico foram menores, demonstrando um padrão de abertura cricofaríngea muito próximo ao encontrado em populações normais
	44,9 (28-62) disfágicos	30 disfágicos	30 disfágicos	Doppler		Análise acústica da deglutição
Jayatilake et al., 2015, Japão¹⁹19 Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529-36.	(22-39) saudáveis	15 saudáveis	8 saudáveis	Microfone	VFD Material de deglutição: grupo saudável, teste de deglutição de água; grupo disfágico, 3 mL de água misturada com bário 25%	Algoritmo de processamento de som da deglutição em tempo real para a avaliação automática, avaliação quantitativa e visualização da capacidade de deglutição	71 deglutições a seco - algoritmo de reconhecimento automático de deglutição atingiu sensibilidade 93,9% em indivíduos saudáveis; o algoritmo detectou automaticamente todos ou alguns dos eventos de deglutição de todos os 31 indivíduos disfágicos e a acurácia geral de detecção para os 92 episódios de deglutição foi de 79,3%	O dispositivo Swallowscope pode analisar os sons da deglutição em tempo real e gerar resultados quantitativos: o número de deglutições e a duração da deglutição, o que pode auxiliar a avaliação à beira do leito e compartilhar os resultados através de um sistema baseado em nuvem. Desempenhos muito bons foram obtidos em termos de valor preditivo positivo e sensibilidade.
	68,8 disfágicos	70 disfágicos	31 disfágicos	Microfone
Leslie et al., 2004, Inglaterra²⁰20 Macaskill PGC, Deeks J, Harbord R, Takwoingi Y. Chapter 10: Analysing and presenting results. In: Collaboration C, editor. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. England: Birmingham; 2010.	72 (24-78) saudáveis	10 saudáveis	10 saudáveis	Estetoscópio	VFD Material de deglutição: 3 bolos cada de 5, 20 mL de bário fino e 5 mL de iogurte	Análise acústica da deglutição	A comparação com a aspiração / penetração definidas por avaliação radiológica mostrou especificidade de 66%, 62% de sensibilidade e o consenso majoritário proporcionou especificidade de 90%, 80% de sensibilidade para detectar a normalidade da deglutição quando o consenso foi alcançado entre os avaliadores.	Melhorar as taxas em pacientes com desempenho ruim melhoraria a precisão geral dessa técnica na previsão de anormalidades na deglutição. O consenso do grupo identificou corretamente 17 dos 20 clipes, portanto podemos especular que o som da deglutição contém pistas audíveis que, em princípio, permitem uma classificação confiável.
	78 (65-90) disfágicos	14 disfágicos	10 disfágicos	Estetoscópio		Análise acústica da deglutição

Grupo	Autor, ano	Tamanho da amostra de indivíduos disfágicos	Tamanho da amostra de controle	Prevalência (%)	Sensibilidade (%)	Especificidade (%)	VPP	VPN	RV +	RV-	ORD	Índice de Youden
Doppler/ VFD	Abdulmassih et al., 2013¹⁸18 David MAL, Alessandro L, Jennifer T, Douglas GA. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;7:1-6.	24	30	50,0^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	80,0^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	100^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	1,00^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,83^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	∞^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,20^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	∞^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,80^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.
Microfone/ VFD	Jayatilake et al., 2015¹⁹19 Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529-36.	31	8	79,4	93,9	29,1^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,83	0,55^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	1,32^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,20^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,20^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,23^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.
Estetoscópio/VFD	Leslie et al., 2004²⁰20 Macaskill PGC, Deeks J, Harbord R, Takwoingi Y. Chapter 10: Analysing and presenting results. In: Collaboration C, editor. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. England: Birmingham; 2010.	14	10	58,3^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	62,0	66,0	0,71^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,55^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	1,82^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,57^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	3,16^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.	0,28^a a Dados calculados pelos autores a partir das informações disponíveis no artigo.

Banco de dados	Pesquisa (8 de outubro de 2016; atualizada em 25 de janeiro de 2017)
Cochrane	"deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow" in Title, Abstract, Keywords and videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies in Title, Abstract, Keywords and ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone in Title, Abstract, Keywords in Trials'
Lilacs	(tw:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow")) AND (tw:(videofluoroscopy OR "videofluoroscopy swallowing study" OR vfss OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)) AND (tw:(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
PubMed	("deglutition"[MeSH Terms] OR "deglutition"[All Fields] OR "deglutitions"[All Fields] OR "swallowing"[All Fields] OR "swallowings"[All Fields] OR "swallows"[MeSH Terms] OR "swallows"[All Fields] OR "swallow"[All Fields]) AND (videofluoroscopy[All Fields] OR "videofluoroscopy swallowing study"[All Fields] OR VFSS OR "videofluoroscopy study"[All Fields] OR "swallowing videofluoroscopy"[All Fields] OR videofluoroscopic[All Fields] OR "videofluoroscopic swallowing"[All Fields] OR "videofluoroscopic swallowing study"[All Fields] OR fluoroscopy[MeSH Terms] OR fluoroscopy[All Fields] OR fluoroscopies) AND (ultrasonography[Subheading] OR ultrasonography[All Fields] OR ultrasound[All Fields] OR ultrasonography[MeSH Terms] OR ultrasound[All Fields] OR ultrasonics[MeSH Terms] OR ultrasonics[Text Word] OR ultrasonics[All Fields] OR "duplex doppler ultrasonography"[All Fields] OR "doppler duplex ultrasonography"[All Fields] OR "acoustic analysis"[All Fields] OR "acoustical analysis"[All Fields] OR auscultation[MeSH Terms] OR auscultation[All Fields] OR "cervical auscultation"[All Fields] OR accelerometry[MeSH Terms] OR accelerometry[All Fields] OR "swallowing accelerometry signals"[All Fields] OR "swallowing sounds"[All Fields] OR "swallow sounds"[All Fields] OR "signal processing"[All Fields] OR acoustics[MeSH Terms] OR acoustics[All Fields] OR acoustic[All Fields] OR "doppler effect"[MeSH Terms] OR doppler effect[Text Word] OR "doppler effect"[All Fields] OR "doppler shift" OR "shift, doppler" OR "effect, doppler" OR "sonar doppler"[All Fields] OR microphone[All Fields])
Scopus	(TITLE-ABS-KEY("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") AND TITLE-ABS-KEY(videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies) AND TITLE-ABS-KEY(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
Web of Science	Tópico:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") ANDTópico: (videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)AND Tópico: (ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
Google Scholar	"deglutition OR swallowing:videofluoroscopy"
Open Grey	swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"
ProQuest	swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"

Indicadores de teste	Análise de dados	Referências
DOR	O valor de um ORD varia de 0 a infinito, com valores maiores indicando melhor desempenho do teste discriminatório. Um valor de 1 significa que um teste não discrimina entre pacientes com o distúrbio e pacientes sem o distúrbio. Valores inferiores a 1 ponto significam interpretação inadequada do teste (mais testes negativos entre os pacientes).	Glas et al.³⁷37 Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003;56:1129-35.
RV	> 1 - diagnóstico de interesse	McGee²⁵25 McGee S. Simplifying likelihood ratios. J Gen Intern Med. 2002;17:647-50.
	0 e 1 - contra o diagnóstico de interesse
	0 - menos provável a doença
	= 1 - falta de valor diagnóstico
Sensibilidade	80% excelente, 70% -80% bom, 60% -69% razoável, < 60% ruim	Não existe consenso na literatura a este respeito
Especificidade	90% excelente, 80% -90% bom, 70% -79% razoável, < 70% ruim	Não existe consenso na literatura a este respeito
Índice de Youden	Os valores do Índice de Youden próximos a 1 indicam alta acurácia; o valor igual a zero equivale a uma estimativa sem informações e indica que um teste não tem valor diagnóstico.	Deeks et al.³⁸38 Deeks JJ, Bossuyt P, Gatsonis C, editors. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. The Cochrane Collaboration. 2010. Available from: http://srdta.cochrane.org/ http://srdta.cochrane.org/...

Autor, Ano	Razão para exclusão
Dudik et al., 2016³⁹39 Dudik JM, Coyle JL, Ei-Jaroudi A, Sun MG, Sejdic E. A matched dual-tree wavelet denoising for tri-axial swallowing vibrations. Biomed Signal Process Control. 2016;27:112-21.	3
Dudik et al., 2015⁴⁰40 Dudik JM, Kurosu A, Coyle JL, Sejdic E. A comparative analysis of DBSCAN, K-means, and quadratic variation algorithms for automatic identification of swallows from swallowing accelerometry signals. Comput Biol Med. 2015;59:10-8.	3
Dudik et al., 2016⁴¹41 Dudik JM, Kurosu A, Coyle JL, Sejdic E. A statistical analysis of cervical auscultation signals from adults with unsafe airway protection. J Neuroeng Rehabil. 2016;13:7.	3
Frakking et al., 2016⁴²42 Frakking T, Chang A, O'Grady K, David M, Weir K. Aspirating and nonaspirating swallow sounds in children: a pilot study. Ann Otol Rhinol Laryngol. 2016;125:1001-9.	3
Frakking et al., 2016⁴³43 Frakking TT, Chang AB, O'Grady KF, David M, Weir KA. Reliability for detecting oropharyngeal aspiration in children using cervical auscultation. Int J Speech Lang Pathol. 2016;:1-9.	3
Golabbakhsh et al., 2014⁴⁴44 Golabbakhsh M, Rajaei A, Derakhshan M, Sadri S, Taheri M, Adibi P. Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease. Dysphagia. 2014;29:572-7.	3
Lee et al., 2006⁴⁵45 Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006;3:14.	3
Mérey et al., 2012⁴⁶46 Merey C, Kushki A, Sejdic E, Berall G, Chau T. Quantitative classification of pediatric swallowing through accelerometry. J Neuroeng Rehabil. 2012;9:34.	3
Morinière et al., 2011⁴⁷47 Moriniere S, Boiron M, Brunereau L, Beutter P, Patat F. Pharyngeal swallowing sound profile assessed after partial and total laryngectomy. Dysphagia. 2011;26:366-73.	3
Movahedi et al., 2016⁴⁸48 Movahedi F, Kurosu A, Coyle JL, Perera S, Sejdic E. Anatomical directional dissimilarities in tri-axial swallowing accelerometry signals. IEEE Trans Neural Syst Rehabil Eng. 2017;25:477-558.	3
Nikjoo et al., 2011³²32 Nikjoo MS, Steele CM, Sejdic E, Chau T. Automatic discrimination between safe and unsafe swallowing using a reputation-based classifier. Biomed Eng Online. 2011;10:100.	3
Reddy et al., 2000⁴⁹49 Reddy NP, Katakam A, Gupta V, Unnikrishnan R, Narayanan J, Canilang EP. Measurements of acceleration during videofluorographic evaluation of dysphagic patients. Med Eng Phys. 2000;22:405-12.	3
Sejdic et al., 2014⁵⁰50 Sejdic E, Dudik JM, Kurosu A, Jestrovic I, Coyle JL. Understanding differences between healthy swallows and penetration-aspiration swallows via compressive sensing of tri-axial swallowing accelerometry signals. Proc SPIE Int Soc Opt Eng. 2014;:9190.	3
Seidic et al., 2013⁵¹51 Sejdic E, Steele CM, Chau T. Classification of penetration-aspiration versus healthy swallows using dual-axis swallowing accelerometry signals in dysphagic subjects. IEEE Trans Biomed Eng. 2013;60:1859-66.	3
Selley et al., 1994⁵²52 Selley WG, Ellis RE, Flack FC, Bayliss CR, Chir B, Pearce VR. The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing. Dysphagia. 1994;9:162-7.	3
Spadotto et al., 2009⁵³53 Spadotto AA, Gatto AR, Guido RC, Montagnoli AN, Cola PC, Pereira JC, et al. Classification of normal swallowing and oropharyngeal dysphagia using wavelet. Appl Math Comput. 2009;207:75-82.	3
Spadotto et al., 2008⁵⁴54 Spadotto AA, Papa JP, Gatto AR, Cola PC, Pereira JC, Guido RC, et al. Denoising swallowing sound to improve the evaluator's qualitative analysis. Comput Electr Eng. 2008;34:148-53.	3
Steele et al., 2013⁵⁵55 Steele CM, Sejdić E, Chau T. Noninvasive detection of thin-liquid aspiration using dual-axis swallowing accelerometry. Dysphagia. 2013;28:105-12.	3
Stroud et al., 2002⁵⁶56 Stroud AE, Lawrie BW, Wiles CM. Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Clin Rehabil. 2002;16:640-5.	3
Tanaka et al., 2012⁵⁷57 Tanaka N, Nohara K, Okuno K, Kotani Y, Okazaki H, Matsumura M, et al. Development of a swallowing frequency meter using a laryngeal microphone. J Oral Rehabil. 2012;39:411-20.	3
Zoratto et al., 2010⁵⁸58 Zoratto DCB, Chau T, Steele CM. Hyolaryngeal excursion as the physiological source of swallowing accelerometry signals. Physiol Meas. 2010;31:843-55.	3
Lazareck et al., 2004⁵⁹59 Lazareck L, Moussavi Z. Classification of normal and dysphagic swallows by acoustical means. IEEE Trans Biomed Eng. 2004;51:2103-12.	3

	Item	Abdulmassih et al., 2013¹⁸18 David MAL, Alessandro L, Jennifer T, Douglas GA. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;7:1-6.	Jayatilake et al., 2015¹⁹19 Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529-36.	Leslie et al., 2004²⁰20 Macaskill PGC, Deeks J, Harbord R, Takwoingi Y. Chapter 10: Analysing and presenting results. In: Collaboration C, editor. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. England: Birmingham; 2010.
Domínio 1: Seleção de paciente	Foi uma amostra consecutiva ou aleatória de pacientes incluídos?	N	N	N
	Um desenho de caso-controle foi evitado?	N	N	N
	O estudo evitou exclusões inadequadas?	S	S	S
	A seleção de pacientes pode ter introduzido viés?	A	A	A
	Questões relativas à aplicabilidade: Existe a preocupação de que os pacientes e as configurações incluídas não correspondem à questão da revisão?	B	B	B
Domínio 2: Teste diagnóstico (Index Test)	Os resultados do teste diagnóstico (index test) foram interpretados sem o conhecimento dos resultados do padrão de referência?	I	I	I
	Se um limiar foi usado, ele foi pré-especificado?	S	S	S
	A condução ou a interpretação do teste diagnóstico (index test) podem ter introduzido um viés?	I	I	B
	Questões relativas à aplicabilidade: Há preocupações de que o teste diagnóstico (index test), a sua condução ou interpretação diferem da questão da revisão?	B	B	B
Domínio 3: Padrão de referência	O padrão de referência provavelmente classificará corretamente a condição-alvo?	S	S	S
	Os resultados do padrão de referência foram interpretados sem o conhecimento dos resultados do teste diagnóstico (index test)?	I	I	I
	O padrão de referência, a sua condução ou interpretação podem ter introduzido viés?	B	B	B
	Questões relativas à aplicabilidade: Há preocupações de que a condição-alvo, conforme definido pelo padrão de referência, não coincida com a questão?	B	B	B
Domínio 4: Fluxo e tempo	Existe um intervalo apropriado entre o(s) teste(s) diagnóstico(s) (index tests) e o padrão de referência?	S	S	S
	Todos os pacientes receberam o mesmo padrão de referência?	S	S	S
	Todos os pacientes foram incluídos na análise?	S	N	N
	O fluxo de pacientes pode ter introduzido o viés?	B	B	B

Database	Search (October 8th 2016; updated on January 25th, 2017)
Cochrane	"deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow" in Title, Abstract, Keywords and videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies in Title, Abstract, Keywords and ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone in Title, Abstract, Keywords in Trials'
LILACS	(tw:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow")) AND (tw:(videofluoroscopy OR "videofluoroscopy swallowing study" OR vfss OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)) AND (tw:(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
PubMed	("deglutition"[MeSH Terms] OR "deglutition"[All Fields] OR "deglutitions"[All Fields] OR "swallowing"[All Fields] OR "swallowings"[All Fields] OR "swallows"[MeSH Terms] OR "swallows"[All Fields] OR "swallow"[All Fields]) AND (videofluoroscopy[All Fields] OR "videofluoroscopy swallowing study"[All Fields] OR VFSS OR "videofluoroscopy study"[All Fields] OR "swallowing videofluoroscopy"[All Fields] OR videofluoroscopic[All Fields] OR "videofluoroscopic swallowing"[All Fields] OR "videofluoroscopic swallowing study"[All Fields] OR fluoroscopy[MeSH Terms] OR fluoroscopy[All Fields] OR fluoroscopies) AND (ultrasonography[Subheading] OR ultrasonography[All Fields] OR ultrasound[All Fields] OR ultrasonography[MeSH Terms] OR ultrasound[All Fields] OR ultrasonics[MeSH Terms] OR ultrasonics[Text Word] OR ultrasonics[All Fields] OR "duplex doppler ultrasonography"[All Fields] OR "doppler duplex ultrasonography"[All Fields] OR "acoustic analysis"[All Fields] OR "acoustical analysis"[All Fields] OR auscultation[MeSH Terms] OR auscultation[All Fields] OR "cervical auscultation"[All Fields] OR accelerometry[MeSH Terms] OR accelerometry[All Fields] OR "swallowing accelerometry signals"[All Fields] OR "swallowing sounds"[All Fields] OR "swallow sounds"[All Fields] OR "signal processing"[All Fields] OR acoustics[MeSH Terms] OR acoustics[All Fields] OR acoustic[All Fields] OR "doppler effect"[MeSH Terms] OR doppler effect[Text Word] OR "doppler effect"[All Fields] OR "doppler shift" OR "shift, doppler" OR "effect, doppler" OR "sonar doppler"[All Fields] OR microphone[All Fields])
Scopus	(TITLE-ABS-KEY("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") AND TITLE-ABS-KEY(videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies) AND TITLE-ABS-KEY(ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
Web of Science	Tópico:("deglutition" OR "deglutitions" OR "swallowing" OR "swallowings" OR "swallows" OR "swallow") ANDTópico: (videofluoroscopy OR "Videofluoroscopy Swallowing Study" OR VFSS OR "videofluoroscopy study" OR "swallowing videofluoroscopy" OR videofluoroscopic OR "videofluoroscopic swallowing" OR "videofluoroscopic swallowing study" OR fluoroscopy OR fluoroscopies)AND Tópico: (ultrasonography OR ultrasound OR ultrasonics OR "duplex doppler ultrasonography" OR "doppler duplex ultrasonography" OR "acoustic analysis" OR "acoustical analysis" OR auscultation OR "cervical auscultation" OR accelerometry OR "swallowing accelerometry signals" OR "swallowing sounds" OR "swallow sounds" OR "signal processing" OR acoustics OR acoustic OR "doppler effect" OR "doppler shift" OR "sonar doppler" OR microphone))
Google Scholar	"deglutition OR swallowing:videofluoroscopy"
Open Grey	Swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"
ProQuest	Swallowing OR deglutition AND videofluoroscopy AND "acoustic analysis"

Test indicators	Data analysis	References
DOR	The value of a DOR ranges from 0 to infinity, with higher values indicating better discriminatory test performance. A value of 1 means that a test does not discriminate between patients with the disorder and those without it. Values lower than 1 point to improper test interpretation (more negative tests among the diseased).	Glas et al.³⁷37 Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003;56:1129-35.
LRs	>1 - diagnostic of interest	McGee²⁵25 McGee S. Simplifying likelihood ratios. J Gen Intern Med. 2002;17:647-50.
	0 and 1 - against the diagnosis of interest
	0 - less likely the disease
	=1 - lack diagnostic valeu
Sensitivity	80% excellent, 70-80% good, 60-69% fair, <60% poor	No consensus in this regard exists in the literature.
Specificity	90% excellent, 80-90% good, 70-79% fair, <70% poor	No consensus in this regard exists in the literature.
Youden's Index	Youden's Index values close to 1 indicate high accuracy; a value of zero is equivalent to uninformed guessing and indicates that a test has no diagnostic value.	Deeks et al.³⁸38 Deeks JJ, Bossuyt P, Gatsonis C, editors. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. The Cochrane Collaboration. 2010. Available from: http://srdta.cochrane.org/ http://srdta.cochrane.org/...

Author, year	Reason for exclusion
Dudik et al., 2016³⁹39 Dudik JM, Coyle JL, Ei-Jaroudi A, Sun MG, Sejdic E. A matched dual-tree wavelet denoising for tri-axial swallowing vibrations. Biomed Signal Process Control. 2016;27:112-21.	3
Dudik et al., 2015⁴⁰40 Dudik JM, Kurosu A, Coyle JL, Sejdic E. A comparative analysis of DBSCAN, K-means, and quadratic variation algorithms for automatic identification of swallows from swallowing accelerometry signals. Comput Biol Med. 2015;59:10-8.	3
Dudik et al., 2016⁴¹41 Dudik JM, Kurosu A, Coyle JL, Sejdic E. A statistical analysis of cervical auscultation signals from adults with unsafe airway protection. J Neuroeng Rehabil. 2016;13:7.	3
Frakking et al., 2016⁴²42 Frakking T, Chang A, O'Grady K, David M, Weir K. Aspirating and nonaspirating swallow sounds in children: a pilot study. Ann Otol Rhinol Laryngol. 2016;125:1001-9.	3
Frakking et al., 2016⁴³43 Frakking TT, Chang AB, O'Grady KF, David M, Weir KA. Reliability for detecting oropharyngeal aspiration in children using cervical auscultation. Int J Speech Lang Pathol. 2016;:1-9.	3
Golabbakhsh et al., 2014⁴⁴44 Golabbakhsh M, Rajaei A, Derakhshan M, Sadri S, Taheri M, Adibi P. Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease. Dysphagia. 2014;29:572-7.	3
Lee et al., 2006⁴⁵45 Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006;3:14.	3
Mérey et al., 2012⁴⁶46 Merey C, Kushki A, Sejdic E, Berall G, Chau T. Quantitative classification of pediatric swallowing through accelerometry. J Neuroeng Rehabil. 2012;9:34.	3
Morinière et al., 2011⁴⁷47 Moriniere S, Boiron M, Brunereau L, Beutter P, Patat F. Pharyngeal swallowing sound profile assessed after partial and total laryngectomy. Dysphagia. 2011;26:366-73.	3
Movahedi et al., 2016⁴⁸48 Movahedi F, Kurosu A, Coyle JL, Perera S, Sejdic E. Anatomical directional dissimilarities in tri-axial swallowing accelerometry signals. IEEE Trans Neural Syst Rehabil Eng. 2017;25:477-558.	3
Nikjoo et al., 2011³²32 Nikjoo MS, Steele CM, Sejdic E, Chau T. Automatic discrimination between safe and unsafe swallowing using a reputation-based classifier. Biomed Eng Online. 2011;10:100.	3
Reddy et al., 2000⁴⁹49 Reddy NP, Katakam A, Gupta V, Unnikrishnan R, Narayanan J, Canilang EP. Measurements of acceleration during videofluorographic evaluation of dysphagic patients. Med Eng Phys. 2000;22:405-12.	3
Sejdic et al., 2014⁵⁰50 Sejdic E, Dudik JM, Kurosu A, Jestrovic I, Coyle JL. Understanding differences between healthy swallows and penetration-aspiration swallows via compressive sensing of tri-axial swallowing accelerometry signals. Proc SPIE Int Soc Opt Eng. 2014;:9190.	3
Seidic et al., 2013⁵¹51 Sejdic E, Steele CM, Chau T. Classification of penetration-aspiration versus healthy swallows using dual-axis swallowing accelerometry signals in dysphagic subjects. IEEE Trans Biomed Eng. 2013;60:1859-66.	3
Selley et al., 1994⁵²52 Selley WG, Ellis RE, Flack FC, Bayliss CR, Chir B, Pearce VR. The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing. Dysphagia. 1994;9:162-7.	3
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	Item	Abdulmassih et al., 2013¹⁸18 David MAL, Alessandro L, Jennifer T, Douglas GA. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;7:1-6.	Jayatilake et al., 2015¹⁹19 Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529-36.	Leslie et al., 2004²⁰20 Macaskill PGC, Deeks J, Harbord R, Takwoingi Y. Chapter 10: Analysing and presenting results. In: Collaboration C, editor. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. England: Birmingham; 2010.
Domain 1: Patient selection	Was a consecutive or random sample of patients enrolled?	N	N	N
	Was a case-control design avoided?	N	N	N
	Did the study avoid inappropriate exclusions?	Y	Y	Y
	Could the selection of patients have introduced bias?	H	H	H
	Concerns regarding applicability: Are there concern that the included patients and settings do not match the review question?	L	L	L
Domain 2: Index test	Were the index test results interpreted without knowledge of the results of the reference standard?	U	U	U
	If a threshold was used, was it prespecified?	Y	Y	Y
	Could the conduct or interpretation of the index test have introduced bias?	U	U	L
	Concerns regarding applicability: Are there concerns that the index test, its conduct, or its interpretation differ from the review question?	L	L	L
Domain 3: Reference standard	Is the reference standard likely to correctly classify the target condition?	Y	Y	Y
	Were the reference standard results interpreted without knowledge of the results of the index test?	U	U	U
	Could the reference standard, its conduct, or its interpretation have introduced bias?	L	L	L
	Concerns regarding applicability: Are there concerns that the target condition as defined by the reference standard does not match the question?	L	L	L
Domain 4: Flow and timing	Was there an appropriate interval between index test(s) and reference standard?	Y	Y	Y
	Did all patients receive the same reference standard?	Y	Y	Y
	Were all patients included in the analysis?	Y	N	N
	Could the patient flow have introduced bias?	L	L	L

[1] * Autor para correspondência. E-mail:karinnavm@hotmail.com, karinna@cb.ufrn.br (K.V. Taveira).

Brasil

Brasil

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