Clinical validation of the RaDI oropharyngeal dysphagia screening tool in older adults.
Raphael Marinho Carvalho, Rafael Maciel de Andrade Lima, Igor Silva de Castro Lima and 4 others
A 9-question dysphagia screening questionnaire (RaDI) correctly flagged 75% of real swallowing problems and 75% of normal swallows in 52 older adults tested against endoscopy.
A negative score does not rule out dysphagia — clinical assessment is still needed.
Key findings
1Against the FEES-plus-clinical-assessment reference standard, the RaDI questionnaire achieved 75% sensitivity, 75% specificity, and 75% overall accuracy in the 52-patient subgroup.
2In the full screened sample, 63 of 284 older adults (22.18%) scored at or above the dysphagia threshold on the RaDI.
3A statistically significant association (p = 0.004, φ = 0.437) was found between a positive RaDI screen and the FEES-confirmed diagnosis, and dysphagia was associated with neurological, pulmonary, and cardiological comorbidities.
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What it does not show
Only 52 of the 284 screened participants underwent the reference-standard examination; the authors attribute this to resource scarcity and participants' inability to return for a second visit, not to random selection. Single centre in one region of Brazil; generalisability to other populations, languages, and healthcare settings is untested. The reference standard is a consensus diagnosis combining FEES findings with a structured clinical speech-language-hearing assessment, not a single objective measure; the 'gold standard' is therefore partly subjective. Cross-sectional design: the screening and the reference standard were administered in the same visit, so temporal changes in swallowing status are not captured. Exclusions (ICU patients, neurocognitive disease, esophageal dysphagia) mean the tool's performance in those groups is unknown. The FEES was performed without topical anaesthesia, which may affect patient cooperation and the completeness of the examination.
Declared interests
No funding source and no conflicts of interest were declared by the authors.
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