Correlations between bedside and instrumental endoscopic parameters in determining severity of dysphagia: an integrated clinical evaluation of safety and efficiency

Interaction between bedside and endoscopic parameters is of great interest in the management of patients with swallowing disorders. Our aim is to document if and how bedside parameters correlate with severity using endoscopic assessment. 556 consecutive patients (318 M/238 F, mean age 65.56 ± 10.36 years, range 18-91), were evaluated in our Swallowing Centre during 2008. All underwent bedside evaluation and fiberoptic endoscopic evaluation of swallowing (FEES), considering the pooling score (p-score) and the pooling sensation, collaboration and age score (p-SCA score) to express criteria of clinical severity of dysphagia. The correlation between the two tests (Spearman correlation coefficient) and their agreement to classify severity (Cohen’s kappa) was defined. After dichotomisation (cut-off: no risk/any kind of risk of aspiration), values of sensitivity and specificity were obtained after comparison with FEES results (gold standard). A close and significant correlation between the p-score and p-SCA score was found (rho = 0.88; p < 0.001). The agreement among scores in attributing the categories of risk is moderate (Cohen’s Kappa = 0.46; p < 0.001).The p-score had a sensitivity of 96% and specificity of 60%, while the p-SCA score has a sensitivity of 98% and specificity of 40%. Our results suggest that including even a few parameter from bedside evaluation to an endoscopic score, the level of severity expressed by the latter, decreases. The evaluation of patients with swallowing disorders should consider as many elements as possible, deriving from non-instrumental and instrumental evaluation (integrated clinical evaluation).