Confidence, Accuracy, and Reliability of Penetration-Aspiration Scale Ratings on Flexible Endoscopic Evaluations of Swallowing by Speech Pathologists

This study investigated rater confidence when rating airway invasion with the penetration-aspiration scale (PAS) on flexible endoscopic evaluations of swallowing (FEES), raters’ accuracy against a referent-standard, inter-rater reliability, and potential associations between clinician confidence, ex...

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Bibliographic Details
Published in:Dysphagia 2024-06, Vol.39 (3), p.504-513
Main Authors: Kitila, Merertu, Borders, James C., Krisciunas, Gintas P., McNally, Edel, Pisegna, Jessica M.
Format: Article
Language:English
Subjects:
Accuracy
Clinical Competence - statistics & numerical data
Confidence
Deglutition - physiology
Deglutition Disorders - diagnosis
Deglutition Disorders - physiopathology
Endoscopy
Endoscopy - methods
Endoscopy - statistics & numerical data
Female
Gastroenterology
Hepatology
Humans
Imaging
Male
Medicine
Medicine & Public Health
Observer Variation
Original Article
Otorhinolaryngology
Radiology
Reproducibility of Results
Respiratory Aspiration - diagnosis
Respiratory tract
Speech-Language Pathology - methods
Swallowing
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Summary:This study investigated rater confidence when rating airway invasion with the penetration-aspiration scale (PAS) on flexible endoscopic evaluations of swallowing (FEES), raters’ accuracy against a referent-standard, inter-rater reliability, and potential associations between clinician confidence, experience, and accuracy. Thirty-one clinicians who use FEES in their daily practice were asked to judge airway invasion with the PAS and to rate their confidence that their score was correct (0–100) for 40 video clips, five in each of the 8 PAS categories. We found that raters were most confident in rating PAS 1, 7, and 8. The average confidence score across all videos was 76/100. Confidence did not have a significant relationship with accuracy against the referent-standard. Accuracy was highest for PAS 1 (92%), followed by PAS 8 (80%), PAS 7 (77%), and PAS 4 (72%). Accuracy was below 60% for PAS 2, 3, 5, and 6, the lowest being for PAS 3 (49%). Mean accuracy for all ratings, compared to referent-standard ratings, was highest for the intermediate group (71%), followed by expert (68%) and novice (65%). In general, we found that certain PAS scores tend to be rated more accurately, and that participating SLPs had varied confidence in PAS ratings on FEES. Potential reasons for these findings as well as suggested next steps are discussed.
ISSN:0179-051X
1432-0460
DOI:10.1007/s00455-023-10635-5