Inter-rater reliability and clinical relevance of subjective and objective interpretation of videofluoroscopy findings.

Background: Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal-abnormal ratings, objective measurements have been developed. We compared the inter-rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods: Two blinded raters analyzed the subjective normal-abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter-rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results: In the pharyngeal findings, the subjective analysis inter-rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter-rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions: The subjective analysis had moderate to strong inter-rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter-observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence: 4.

The Water Swallow Test and EAT-10 as Screening Tools for Referral to Videofluoroscopy.

BACKGROUND: Videofluoroscopy (VFS) is the gold standard in evaluating dysphagia. Water swallow tests (WST) and the Eating Assessment Tool (EAT-10) are commonly used in dysphagia screening. We aimed to determine the feasibility of WST and EAT-10 as screening tools for referral to VFS. METHODS: Patients (n = 150, median age: 70.0 years, range: 19-92 years, 58.7% female) referred to VFS completed the WST and EAT-10 before the examination. In the WST, we evaluated both the qualitative parameters (coughing, possible change in voice) and quantitative parameters (average drinking bolus size, swallowing speed). Correlations of EAT-10 total scores and WST parameters to the VFS findings were analyzed both individually and combined. RESULTS: In the WST, the most specific (89.7%) predictor of normal VFS findings was the absence of coughing, and the most sensitive (79.1%) parameter to predict abnormal findings was a bolus size of ≤20 mL. Using a combination of coughing and a bolus size ≤20 mL (simplified WST), the sensitivity of predicting abnormal findings increased to 83.5%. The most sensitive (84.6%) predictor of penetration/aspiration was failing any parameter in the WST. Lack of coughing indicated an absence of penetration/aspiration with an 82.5% specificity. Swallowing speed or combining the EAT-10 results with the WST results did not enhance the sensitivity or specificity of the WST for predicting the VFS results. CONCLUSIONS: Coughing and average drinking bolus size are the most important parameters in WST when screening for referral to VFS, whereas the swallowing speed does not seem to be useful. The WST is superior to EAT-10 in predicting VFS findings. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1349-1355, 2024.