Development of a three-item short form of the EAT-10 for screening suspected dysphagia in hospitalized older adults: findings from a multicentre study.

AIM: To develop a three-item short form of the EAT-10 by identifying the smallest subset of items that preserves the screening performance of the full questionnaire in hospitalized older adults. DESIGN: Multicentre cross-sectional observational study. METHODS: The study was conducted in nine public hospitals in Spain within the NUTRIFAG project. Hospitalized patients aged ≥65 years with a length of stay ≥48 h were included. Patients receiving enteral or parenteral nutrition at admission, those in terminal condition, or with a primary diagnosis of cancer were excluded. Suspected dysphagia was assessed using the Eating Assessment Tool (EAT-10), with a score ≥3 considered positive. Multivariate logistic regression models with forward item selection were used to identify the most informative symptoms indicators. The sample was randomly divided into a training subset (60%) and an internal assessment subset (40%). Model performance was evaluated using Nagelkerke's pseudo R 2, the Hosmer-Lemeshow test, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). RESULTS: The sample included 2,519 participants. Three symptom indicators emerged as the most informative for identifying patients with suspected dysphagia: requiring extra effort to swallow liquids, requiring extra effort to swallow solids, and coughing while eating. Together, these indicators showed high agreement with the classification obtained using the full EAT-10 in the training phase (R 2 = 0.861; sensitivity = 0.863; specificity = 0.979; AUC = 0.982), which similar classification performance in the internal assessment subset (sensitivity = 0.881; specificity = 0.984). CONCLUSION: The proposed three-item subset represents a shortened version of the EAT-10 that preserved much of the screening performance of the full questionnaire in hospitalized older adults. Although it may facilitate dysphagia screening by reproducing the classification obtained with the full EAT-10 in routine nursing assessment, independent external validation against clinical reference standards is required before its diagnostic use can be recommended.