{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:16:10Z","timestamp":1790637370702,"version":"4.1.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Oropharyngeal dysphagia is highly prevalent among hospitalized geriatric patients. The screening instruments used to date have been evaluated primarily in stroke patients. This diagnostic study aimed to validate a new screening instrument for oropharyngeal dysphagia, the \u2018Dysphagia Screening Tool for Geriatric Patients\u2019 (DSTG), as compared to one of the gold standards, flexible endoscopic evaluation of swallowing (FEES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Geriatric inpatients admitted to five geriatric hospitals in Germany were consecutively evaluated using both DSTG and FEES in random order and by different evaluators blinded to the results of the other evaluation. In the FEES examination, a score of more than 3 on Rosenbek\u2019s Penetration Aspiration Scale was considered evidence of clinically relevant oropharyngeal dysphagia. Sensitivity, specificity and further measures of test performance were calculated for DSTG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 53 volunteers recruited were on average 85 years of age, 56.6% were women. Twenty patients (37.7%) were diagnosed with dysphagia using FEES. Of these, 12 were screened as positive on DSTG. Of the 33 FEES negative patients, 4 tested positive on DSTG. The following test parameters were calculated for DSTG: sensitivity: 0.60, 95% confidence interval [0.39 ; 0.78], specificity 0.88 [0.73 ; 0.95], positive predictive value 0.75 [0.51 ; 0.90], negative predictive value 0.78 [0.63 ; 0.89], positive likelihood ratio 4.95 [1.85 ; 13.27], negative likelihood ratio 0.46 [0.26 ; 0.79]. In a receiver-operator characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.77 [0.62 ; 0.91]. No adverse events occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The DSTG appears to be a valid instrument for screening of oropharyngeal dysphagia in geriatric inpatients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-023-04516-7","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T13:02:44Z","timestamp":1702558964000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Diagnostic accuracy of the \u2018Dysphagia Screening Tool for Geriatric Patients\u2019 (DSTG) compared to Flexible Endoscopic Evaluation of Swallowing (FEES) for assessing dysphagia in hospitalized geriatric patients \u2013 a diagnostic study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2181-6872","authenticated-orcid":false,"given":"Ulrich","family":"Thiem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"J\u00e4ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Stege","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Wirth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"4516_CR1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.2147\/CIA.S97481","volume":"11","author":"R Wirth","year":"2016","unstructured":"Wirth R, Dziewas R, Beck AM, Clav\u00e9 P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, et al. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189\u2013208.","journal-title":"Clin Interv Aging"},{"issue":"2","key":"4516_CR2","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S0016-5085(99)70144-7","volume":"116","author":"IJ Cook","year":"1999","unstructured":"Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455\u201378.","journal-title":"Gastroenterology"},{"issue":"6","key":"4516_CR3","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1016\/0016-5085(89)90391-0","volume":"97","author":"P Jacob","year":"1989","unstructured":"Jacob P, Kahrilas PJ, Logemann JA, Shah V, Ha T. Upper esophageal sphincter opening and modulation during swallowing. Gastroenterology. 1989;97(6):1469\u201378.","journal-title":"Gastroenterology"},{"issue":"1","key":"4516_CR4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/PL00009544","volume":"13","author":"SB Leder","year":"1998","unstructured":"Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia. 1998;13(1):19\u201321.","journal-title":"Dysphagia"},{"key":"4516_CR5","doi-asserted-by":"crossref","unstructured":"Ramsey D, Smithard D, Kalra L. Silent aspiration: what do we know? Dysphagia 2005, 20(3):218\u201325.","DOI":"10.1007\/s00455-005-0018-9"},{"issue":"1","key":"4516_CR6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/S0003-9993(98)90200-3","volume":"79","author":"SK Daniels","year":"1998","unstructured":"Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute Stroke. Arch Phys Med Rehabil. 1998;79(1):14\u20139.","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"4516_CR7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/BF00262752","volume":"9","author":"J Schmidt","year":"1994","unstructured":"Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts Pneumonia and death but not dehydration following Stroke. Dysphagia. 1994;9(1):7\u201311.","journal-title":"Dysphagia"},{"issue":"6","key":"4516_CR8","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.2214\/ajr.180.6.1801613","volume":"180","author":"L Pikus","year":"2003","unstructured":"Pikus L, Levine MS, Yang YX, Rubesin SE, Katzka DA, Laufer I, Gefter WB. Videofluoroscopic studies of swallowing dysfunction and the relative risk of Pneumonia. AJR Am J Roentgenol. 2003;180(6):1613\u20136.","journal-title":"AJR Am J Roentgenol"},{"issue":"10","key":"4516_CR9","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1001\/archneur.1994.00540220099020","volume":"51","author":"MA Holas","year":"1994","unstructured":"Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of Medical Complications following Stroke. Arch Neurol. 1994;51(10):1051\u20133.","journal-title":"Arch Neurol"},{"issue":"12","key":"4516_CR10","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","volume":"36","author":"R Martino","year":"2005","unstructured":"Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after Stroke: incidence, diagnosis, and pulmonary Complications. Stroke. 2005;36(12):2756\u201363.","journal-title":"Stroke"},{"issue":"2","key":"4516_CR11","doi-asserted-by":"publisher","first-page":"e0148424","DOI":"10.1371\/journal.pone.0148424","volume":"11","author":"M Arnold","year":"2016","unstructured":"Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML, El-Koussy M, K\u00e4gi G, Jung S, Sarikaya H. Dysphagia in Acute Stroke: incidence, Burden and Impact on Clinical Outcome. PLoS ONE. 2016;11(2):e0148424.","journal-title":"PLoS ONE"},{"issue":"3","key":"4516_CR12","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.clnu.2014.04.014","volume":"34","author":"S Carri\u00f3n","year":"2015","unstructured":"Carri\u00f3n S, Cabr\u00e9 M, Monteis R, Roca M, Palomera E, Serra-Prat M, Rofes L, Clav\u00e9 P. Oropharyngeal dysphagia is a prevalent risk factor for Malnutrition in a cohort of older patients admitted with an acute Disease to a general hospital. Clin Nutr. 2015;34(3):436\u201342.","journal-title":"Clin Nutr"},{"key":"4516_CR13","doi-asserted-by":"crossref","unstructured":"Melgaard D, Rodrigo-Domingo M, M\u00f8rch MM. The prevalence of Oropharyngeal Dysphagia in Acute geriatric patients. Geriatr (Basel Switzerland). 2018;3(2).","DOI":"10.3390\/geriatrics3020015"},{"key":"4516_CR14","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.2147\/CIA.S107750","volume":"11","author":"LW Baijens","year":"2016","unstructured":"Baijens LW, Clav\u00e9 P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, et al. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403\u201328.","journal-title":"Clin Interv Aging"},{"issue":"11","key":"4516_CR15","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1177\/000348940711601112","volume":"116","author":"N Roy","year":"2007","unstructured":"Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858\u201365.","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"1","key":"4516_CR16","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1007\/s00455-016-9746-2","volume":"32","author":"R Dziewas","year":"2017","unstructured":"Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore SE, Leischker A, Martino R, Pluschinski P, Roesler A, et al. Recognizing the importance of Dysphagia: stumbling blocks and stepping stones in the twenty-First Century. Dysphagia. 2017;32(1):78\u201382.","journal-title":"Dysphagia"},{"issue":"2","key":"4516_CR17","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1111\/j.1741-6612.2011.00537.x","volume":"30","author":"anonymous: Australian and New Zealand Society for Geriatric Medicine","year":"2011","unstructured":"anonymous: Australian and New Zealand Society for Geriatric Medicine. Position statement - dysphagia and aspiration in older people*. Australas J Ageing. 2011;30(2):98\u2013103.","journal-title":"Australas J Ageing"},{"key":"4516_CR18","first-page":"69","volume":"2","author":"T Rittig","year":"2009","unstructured":"Rittig T, J\u00e4ger M, F\u00fcsgen I. Pr\u00e4valenz Und Bedeutung Bei Patienten in Geriatrischen Einrichtungen - Eine Biometrische Multicenter Studie. Eur J Geriatr. 2009;2:69\u201378.","journal-title":"Eur J Geriatr"},{"issue":"6","key":"4516_CR19","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1159\/000235824","volume":"55","author":"SB Leder","year":"2009","unstructured":"Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000\u20132007. Gerontology. 2009;55(6):714\u20138.","journal-title":"Gerontology"},{"issue":"3","key":"4516_CR20","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1093\/gerona\/glt099","volume":"69","author":"M Cabre","year":"2014","unstructured":"Cabre M, Serra-Prat M, Force L, Almirall J, Palomera E, Clave P. Oropharyngeal dysphagia is a risk factor for readmission for Pneumonia in the very elderly persons: observational prospective study. J Gerontol A Biol Sci Med Sci. 2014;69(3):330\u20137.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"4516_CR21","unstructured":"anonymous. : Management of patients with Stroke: Identifikation Und Management of Dysphagia. Scott Intercoll Guidelines Netw. 2010;119."},{"issue":"4","key":"4516_CR22","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1055\/s-0033-1343317","volume":"38","author":"R Wirth","year":"2013","unstructured":"Wirth R, Dziewas R, J\u00e4ger M, Warnecke T, Smoliner C, Stingel K, Leischker AH. DGEM Steering Committee: Leitlinie Der Deutschen Gesellschaft f\u00fcr Ern\u00e4hrungsmedizin (DGEM) in Zusammenarbeit Mit Der GESKES, Der AKE, Der DGN Und Der DGG. Aktuel Ernahrungsmed. 2013;38(4):e49\u2013e89.","journal-title":"Aktuel Ernahrungsmed"},{"issue":"11","key":"4516_CR23","doi-asserted-by":"publisher","first-page":"2948","DOI":"10.1161\/STROKEAHA.107.483933","volume":"38","author":"M Trapl","year":"2007","unstructured":"Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia bedside screening for acute-stroke patients: the gugging swallowing screen. Stroke. 2007;38(11):2948\u201352.","journal-title":"Stroke"},{"key":"4516_CR24","unstructured":"Deutsche Gesellschaft f\u00fcr Neurologie (DGN). Leitlinie Neurogene Dysphagie. 2020. https:\/\/www.dgnorg\/leitlinien\/ll-030-111-neurogene-dysphagie-2020\/"},{"issue":"6","key":"4516_CR25","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.clnu.2008.06.011","volume":"27","author":"P Clave","year":"2008","unstructured":"Clave P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806\u201315.","journal-title":"Clin Nutr"},{"issue":"3","key":"4516_CR26","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s00391-020-01712-7","volume":"53","author":"M J\u00e4ger","year":"2020","unstructured":"J\u00e4ger M, Thiem U, Stege H. [Development of a new screening instrument for screening of dysphagia in geriatric patients: the dysphagia screening tool geriatrics]. Z Gerontol Geriatr. 2020;53(3):239\u201344.","journal-title":"Z Gerontol Geriatr"},{"issue":"6","key":"4516_CR27","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676\u201382.","journal-title":"Am J Epidemiol"},{"issue":"4","key":"4516_CR28","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1007\/s00391-004-0233-2","volume":"37","author":"N L\u00fcbke","year":"2004","unstructured":"L\u00fcbke N, Meinck M, Von Renteln-Kruse W. [The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual]. Z Gerontol Geriatr. 2004;37(4):316\u201326.","journal-title":"Z Gerontol Geriatr"},{"issue":"4","key":"4516_CR29","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1007\/s11136-014-0838-x","volume":"24","author":"I Buchholz","year":"2015","unstructured":"Buchholz I, Thielker K, Feng YS, Kupatz P, Kohlmann T. Measuring changes in health over time using the EQ-5D 3L and 5L: a head-to-head comparison of measurement properties and sensitivity to change in a German inpatient rehabilitation sample. Qual Life Res. 2015;24(4):829\u201335.","journal-title":"Qual Life Res"},{"key":"4516_CR30","unstructured":"Langmore S. Endoscopic Evaluation and Treatment of Swallowing Disorders. Thieme - New York, Stuttgart 2001."},{"issue":"4","key":"4516_CR31","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/BF02414429","volume":"2","author":"SE Langmore","year":"1988","unstructured":"Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2(4):216\u20139.","journal-title":"Dysphagia"},{"issue":"2","key":"4516_CR32","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00417897","volume":"11","author":"JC Rosenbek","year":"1996","unstructured":"Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93\u20138.","journal-title":"Dysphagia"},{"issue":"4","key":"4516_CR33","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1007\/s00106-013-2815-z","volume":"62","author":"C Hey","year":"2014","unstructured":"Hey C, Pluschinski P, Zaretsky Y, Almahameed A, Hirth D, Vaerst B, Wagenblast J, St\u00f6ver T. [Penetration-Aspiration scale according to Rosenbek. Validation of the German version for endoscopic dysphagia diagnostics]. HNO. 2014;62(4):276\u201381.","journal-title":"HNO"},{"key":"4516_CR34","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","volume":"48","author":"K Hajian-Tilaki","year":"2014","unstructured":"Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193\u2013204.","journal-title":"J Biomed Inform"},{"issue":"4","key":"4516_CR35","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1044\/1058-0360.0604.17","volume":"6","author":"SK Daniels","year":"1997","unstructured":"Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical Assessment of Swallowing and Prediction of Dysphagia Severity. Am J Speech Lang Pathol. 1997;6(4):17\u201324.","journal-title":"Am J Speech Lang Pathol"},{"issue":"12","key":"4516_CR36","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/archneur.1992.00530360057018","volume":"49","author":"KL De Pippo","year":"1992","unstructured":"De Pippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following Stroke. Arch Neurol. 1992;49(12):1259\u201361.","journal-title":"Arch Neurol"},{"issue":"10","key":"4516_CR37","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3109\/09638289609166040","volume":"18","author":"D Gottlieb","year":"1996","unstructured":"Gottlieb D, Kipnis M, Sister E, Vardi Y, Brill S. Validation of the 50 ml3 drinking test for evaluation of post-stroke dysphagia. Disabil Rehabil. 1996;18(10):529\u201332.","journal-title":"Disabil Rehabil"},{"issue":"2","key":"4516_CR38","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1161\/STROKEAHA.107.510370","volume":"40","author":"R Martino","year":"2009","unstructured":"Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside swallowing screening test (TOR-BSST): development and validation of a dysphagia screening tool for patients with Stroke. Stroke. 2009;40(2):555\u201361.","journal-title":"Stroke"},{"issue":"8","key":"4516_CR39","first-page":"637","volume":"69","author":"ML Splaingard","year":"1988","unstructured":"Splaingard ML, Hutchins B, Sulton LD, Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil. 1988;69(8):637\u201340.","journal-title":"Arch Phys Med Rehabil"},{"issue":"9","key":"4516_CR40","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1111\/nmo.12382","volume":"26","author":"L Rofes","year":"2014","unstructured":"Rofes L, Arreola V, Mukherjee R, Clav\u00e9 P. Sensitivity and specificity of the Eating Assessment Tool and the volume-viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):1256\u201365.","journal-title":"Neurogastroenterol Motil"},{"key":"4516_CR41","doi-asserted-by":"crossref","unstructured":"McGee S. Evidence-based Physical Diagnosis. Saunders 2001, 1. edition.","DOI":"10.1016\/B978-0-323-39276-1.00001-9"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-023-04516-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-023-04516-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-023-04516-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T13:02:59Z","timestamp":1702558979000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgeriatr.biomedcentral.com\/articles\/10.1186\/s12877-023-04516-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,14]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["4516"],"URL":"https:\/\/doi.org\/10.1186\/s12877-023-04516-7","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,14]]},"assertion":[{"value":"9 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 November 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Ethics Committee of the Medical Faculty of the Ruhr-Universit\u00e4t Bochum, Germany (Vote no. 16-5661, June 20, 2016). The study was performed in accordance with the Declaration of Helsinki. Written informed consent has been obtained from all study participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interest in relation to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"856"}}