Characterizing the Validity of Using VASES to Derive DIGEST-FEES Grades.
James A Curtis, Lauren Tabor Gray, Loni Arrese and 2 others
PMID 38631299WHAT IT FOUND
Speech-language pathologists can use VASES ratings to derive DIGEST-FEES grades with almost perfect agreement to the original method.
This saves time by avoiding double-rating swallows, though the grades are not identical and may shift slightly in severity.
Key findings
01VASES-derived DIGEST-FEES grades showed 'almost perfect' agreement with original DIGEST-FEES grades for safety and total scores, and 'substantial' agreement for efficiency.
02Using the maximum residue rating from either the oropharynx or hypopharynx was the most valid method to derive a single pharyngeal residue score for DIGEST-FEES from VASES data.
03There were no statistically significant differences between original and VASES-derived grades, and both methods correlated similarly with patient-reported quality of life and functional intake measures.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study only included patients with head and neck cancer, so it is unknown if this validity holds for other populations like stroke or neurodegenerative disease. Only two raters participated, both PhD-level experts with extensive FEES experience. The methods for combining VASES residue ratings into a single DIGEST score were based on expert opinion, not empirical optimization, though all tested combinations performed similarly.
Declared interests
The authors declared no conflicts of interest. The study was supported in part by a grant from the American Speech-Language-Hearing Foundation.
The easy way to misread this
Do not assume the VASES-derived DIGEST-FEES grades are identical to the original DIGEST-FEES grades. While they are highly correlated, 38-40% of the grades did not match exactly, meaning a patient's severity rating could shift by one grade depending on the method used.