DEGLUTO: initial validity evidence of a clinical swallowing assessment tool for adults.

The study reports no diagnostic accuracy. The authors state that sensitivity, specificity and predictive values were not examined, so it is not known whether DEGLUTO correctly identifies which patients have dysphagia compared with a gold standard such as videofluoroscopy or FEES. The expert panel shrank across the three rounds, from 13 judges in round one to 9 in round three, and judges were chosen by convenience based on reputation and experience rather than selected at random. The 210 patients were a convenience sample from hospitals and clinics in one Brazilian city, with a mean age of 73.67 years and mostly women, so the results may not carry to younger adults or to other health systems. One item met the 70% agreement threshold when the judges reassessed it in round three, but was then dropped after the field-testing stage, so the final item set changed after the content-validity stage had closed. The text says the CVI and CVC were above 0.90 for 20 of the 21 items, but the paper's own per-item table shows a second item, 'absentmindedness or fluctuating alertness', with a CVI of 0.71, below the stated acceptance level. Application time and acceptability were reported by the same clinicians who applied the instrument, without an independent assessor.

The paper states that there was no financial support to declare and nothing to declare under funding and conflicts of interest. No industry involvement is reported.

Agreement between assessors is not the same as accuracy. This study shows that experts and clinicians agreed on what DEGLUTO's items mean and found the tool usable; it does not show that DEGLUTO identifies people with dysphagia correctly. The authors state that sensitivity, specificity and predictive values were not examined, so do not use it in place of instrumental assessment on the strength of this paper.