Interrater reliability of videofluoroscopic swallow evaluation

Area of Science:

• Medicine
• Otolaryngology
• Radiology

Background:

• Swallowing disorders (dysphagia) are increasingly recognized.
• X-ray videofluoroscopy is the primary method for evaluating swallowing.
• Interobserver reliability of videofluoroscopy assessments is not well-established.

Purpose of the Study:

• To assess the interobserver reliability of videofluoroscopy for swallow evaluation.
• To identify parameters with high and low reliability in videofluoroscopy assessments.

Main Methods:

• Fifty-one dysphagic patients underwent videofluoroscopy.
• Nine experienced observers evaluated the first swallow (5 ml of contrast media) using a standardized protocol.
• Interobserver reliability was calculated using kappa coefficients and intraclass correlation.

Main Results:

• Reliability for oral and pharyngeal phase parameters, penetration/aspiration timing, and bolus residue location was generally poor (kappa 0.01-0.56).
• High reliability (intraclass coefficient 0.80) was achieved only for the standardized penetration/aspiration score.
• The reliability of most oropharyngeal swallow parameters assessed by videofluoroscopy is poor.

Conclusions:

• Exact definitions for videofluoroscopy parameters are needed to improve interobserver reliability.
• Currently, only aspiration is reliably assessed using videofluoroscopy.
• Enhancing standardization is critical for accurate dysphagia diagnosis and intervention planning.