Reflections on Clinical and Statistical Use of the Penetration-Aspiration Scale.
Catriona M Steele, Karen Grace-Martin
PMID 28534064WHAT IT FOUND
Averaging PAS scores to decimal places can misrepresent patients.
Levels 4 and 6 are rare. The authors recommend frequency patterns or ordered categories, not proof that a treatment works.
Key findings
01PAS levels 4 and 6 are rarely observed, including in the illustrative dataset.
02A decimal mean PAS score, such as 4.42, can represent a value that rarely or never happens.
03The authors propose a 4-level Categorical PAS, but it has not undergone validation.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is an expert reflection and tutorial, not a new clinical trial, and the authors state their comments reflect opinions. The proposed 4-level Categorical PAS has not been validated. The statistical examples use a hypothetical dataset, not real patient data. Using worst PAS scores can skew the impression toward impairment. FEES may not reliably detect ejection scores because of white-out during the swallow. The PAS does not capture aspirant volume, timing, or mechanism.
The easy way to misread this
Do not read the proposed Categorical PAS as a validated replacement for the 8-point scale. It has not undergone validation, and the article uses hypothetical data rather than a clinical trial.