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Subjective Assessment of Videofluoroscopic Swallow Studies.

Publication ,  Journal Article
Lee, JW; Randall, DR; Evangelista, LM; Kuhn, MA; Belafsky, PC
Published in: Otolaryngol Head Neck Surg
May 2017

Objective The videofluoroscopic swallow study (VFSS) is the gold standard diagnostic tool to evaluate oropharyngeal dysphagia. Although objective measurements on VFSS have been described, there is no universal method of analysis, and the majority of clinicians use subjective interpretation alone. The purpose of this investigation was to evaluate the accuracy of subjective VFSS analysis. Study Design Double-blinded experiment. Setting Tertiary care laryngology center. Subjects and Methods Seventy-six de-identified videos from VFSS evaluations of patients with dysphagia were presented to blinded, experienced speech-language pathologists and laryngologists individually. Evaluators rated each video as normal or abnormal for hyoid elevation (HE), pharyngeal area (PA), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). A blinded investigator assessed evaluators' inter- and intrarater agreement and compared their responses to objectively measured results for these parameters to examine accuracy. Results Evaluators correctly classified only 61.5% of VFSS videos as normal or abnormal, with moderate interrater agreement (κ = 0.48, P < .0001). Intrarater agreement was highly variable (κ = 0.43-0.83). Accuracy was greatest for PCR (71.6%), with poorer performance for HE (61.3%), PESo (59.2%), and PA (45.3%). Interrater agreement was moderate for all parameters, with greater concordance for PCR (κ = 0.59) and PESo (κ = 0.54) and less for HE (κ = 0.40) and PA (κ = 0.44). Evaluators unanimously agreed on a correct interpretation of a VFSS only 28% of the time. Conclusion Subjective assessment of VFSS parameters is inconsistently accurate when compared with objective measurements, with accuracy ratings ranging from 45.3% to 71.6% for specific parameters. Inter- and intrarater reliability for subjective assessment was moderate and highly variable.

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Published In

Otolaryngol Head Neck Surg

DOI

EISSN

1097-6817

Publication Date

May 2017

Volume

156

Issue

5

Start / End Page

901 / 905

Location

England

Related Subject Headings

  • Video Recording
  • Tertiary Care Centers
  • Severity of Illness Index
  • Otorhinolaryngology
  • Otolaryngology
  • Observer Variation
  • Middle Aged
  • Male
  • Humans
  • Fluoroscopy
 

Citation

APA
Chicago
ICMJE
MLA
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Lee, J. W., Randall, D. R., Evangelista, L. M., Kuhn, M. A., & Belafsky, P. C. (2017). Subjective Assessment of Videofluoroscopic Swallow Studies. Otolaryngol Head Neck Surg, 156(5), 901–905. https://doi.org/10.1177/0194599817691276
Lee, Janet W., Derrick R. Randall, Lisa M. Evangelista, Maggie A. Kuhn, and Peter C. Belafsky. “Subjective Assessment of Videofluoroscopic Swallow Studies.Otolaryngol Head Neck Surg 156, no. 5 (May 2017): 901–5. https://doi.org/10.1177/0194599817691276.
Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective Assessment of Videofluoroscopic Swallow Studies. Otolaryngol Head Neck Surg. 2017 May;156(5):901–5.
Lee, Janet W., et al. “Subjective Assessment of Videofluoroscopic Swallow Studies.Otolaryngol Head Neck Surg, vol. 156, no. 5, May 2017, pp. 901–05. Pubmed, doi:10.1177/0194599817691276.
Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective Assessment of Videofluoroscopic Swallow Studies. Otolaryngol Head Neck Surg. 2017 May;156(5):901–905.
Journal cover image

Published In

Otolaryngol Head Neck Surg

DOI

EISSN

1097-6817

Publication Date

May 2017

Volume

156

Issue

5

Start / End Page

901 / 905

Location

England

Related Subject Headings

  • Video Recording
  • Tertiary Care Centers
  • Severity of Illness Index
  • Otorhinolaryngology
  • Otolaryngology
  • Observer Variation
  • Middle Aged
  • Male
  • Humans
  • Fluoroscopy