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
PMID 42561350WHAT IT FOUND
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
01Against the FEES-plus-clinical-assessment reference standard, the RaDI questionnaire achieved 75% sensitivity, 75% specificity, and 75% overall accuracy in the 52-patient subgroup.
02In the full screened sample, 63 of 284 older adults (22.18%) scored at or above the dysphagia threshold on the RaDI.
03A 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.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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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.
The easy way to misread this
Do not treat a negative RaDI score as ruling out dysphagia. The tool's sensitivity was 75% in the 52-patient FEES subgroup, meaning a meaningful number of true cases will be missed, and that subgroup was limited by resource constraints rather than random selection from the full 284.