Does Inclusion of Thickened Liquids in a Modified Barium Swallow Study (MBSS) Protocol Affect DIGEST Grades?
Ryan J Burdick, Jenni Wu, Ella Aldridge and 6 others
PMID 41128846WHAT IT FOUND
Adding thickened liquids to a standard swallowing scan rarely changes the DIGEST score.
In most cases, the impairment grade stays exactly the same. When it does change, the score worsens by one point, usually because safety issues appear on the thicker liquid that were missed on thin liquid.
Key findings
01Agreement between DIGEST grades calculated with and without thickened liquids was near-perfect to perfect, with percent agreement ranging from 92 to 100%.
02When discrepancies occurred, the DIGEST grade invariably worsened by one level, most often driven by the Safety parameter.
03There was no single consistent bolus volume or consistency that drove these rare changes, though 20 mL mildly thick liquid was the most common driver when comparing core to core plus mildly thick protocols.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Moderately thick liquid data was only available for a small subset of 24 patients, all of whom had Alzheimer's disease and dysphagia, limiting generalizability to other populations for this specific consistency. The study protocol did not include repeated bolus trials, so the effect of multiple swallows of the same consistency on DIGEST grading is unknown. The 'core' protocol used in this study differed slightly from the original DIGEST validation protocol (excluding one 10 mL thin bolus and replacing cup sips with 20 mL thin liquid boluses), though it remained within recommended minimums.
Declared interests
The study was funded by the National Cancer Institute.
The easy way to misread this
Do not conclude that thickened liquids are unnecessary for clinical assessment. This study only addresses whether they change the DIGEST grade score. Thickened liquids may still reveal important physiological impairments or guide treatment decisions, even if the DIGEST Safety or Efficiency grade remains the same as the thin liquid trial.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →