Stanford University, CA.
University of Wisconsin School of Medicine and Public Health, Madison.
J Speech Lang Hear Res. 2021 Jun 4;64(6):1802-1810. doi: 10.1044/2021_JSLHR-21-00014. Epub 2021 May 25.
Purpose While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as bolus-level penetration-aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes research. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results Interrater reliability was almost perfect for overall DIGEST-FEES grade (κ = 0.83) and safety grade (κ = 0.86) and substantial for efficiency grade (κ = 0.74). Intrarater reliability was excellent for all raters (0.9-0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory ( = -.43, < .0001), Functional Oral Intake Scale ( = -.43, < .0001), Secretion Severity Scale ( = .47, < .0001), Yale Vallecular Residue ( = .73, < .0001), and Yale Pyriform Sinus Residue ( = .65, < .0001). Conclusion DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC. Supplemental Material https://doi.org/10.23641/asha.14642787.
目的 尽管灵活的吞咽评估（FEES）是头颈部癌症（HNC）人群中常用的临床程序，但 FEES 的现有结局测量方法，如食团级别渗透-吸入和残留评分，并不适合作为合作组试验或临床结果研究中吞咽困难严重程度的整体患者水平终点测量方法。动态影像吞咽毒性分级（DIGEST）最初是为了在透视吞咽评估中使用而开发和验证的，作为一种分级安全性、效率和整体咽部吞咽障碍的方法。本研究的目的是改编和验证 DIGEST 以用于 FEES。 方法 采用改良 Delphi 法进行内容验证、专家共识、改编和操作化。然后，三位盲法、专家评分者评估了 100 例 HNC 治疗后 FEES 检查。使用二次加权 kappa 测试内部和外部评分者的可靠性。使用 Spearman 相关系数评估与 MD 安德森吞咽障碍量表、功能性口腔摄入量表、分泌严重程度量表和耶鲁残留评分量表的标准相关性。 结果 整体 DIGEST-FEES 分级（κ=0.83）和安全性分级（κ=0.86）的外部评分者间可靠性几乎为完美，效率分级（κ=0.74）的外部评分者间可靠性为实质性。所有评分者的内部评分者间可靠性均为优秀（0.9-0.91）。总体 DIGEST-FEES 分级与 MD 安德森吞咽障碍量表（r=-.43，<0.0001）、功能性口腔摄入量表（r=-.43，<0.0001）、分泌严重程度量表（r=-.47，<0.0001）、耶鲁梨状隐窝残留（r=-.73，<0.0001）和耶鲁 Pyriform 窦残留（r=-.65，<0.0001）相关。 结论 DIGEST-FEES 是一种有效的、可靠的量表，可以描述 HNC 患者的咽吞咽困难严重程度。
