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Related Experiment Video

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Validation of the secretion severity rating scale.

Petra Pluschinski1, Eugen Zaretsky1, Timo Stöver2

  • 1Department of Phoniatrics and Pediatric Audiology, University Hospital of Marburg, Baldingerstr. 1, 35032, Marburg, Germany.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|May 14, 2016
PubMed
Summary

This study validates the Murray secretion scale for assessing dysphagia severity. The scale demonstrates high reliability and validity, making it a valuable tool for clinical practice.

Keywords:
DysphagiaFEES ®Secretion scaleSwallowing disorderValidity

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Area of Science:

  • Otolaryngology
  • Speech-Language Pathology
  • Gastroenterology

Background:

  • Accumulation of secretions in the hypopharynx, larynx, and trachea is a key indicator of severe dysphagia.
  • Accurate assessment of secretion severity is crucial for effective clinical management and therapeutic interventions.
  • The Murray secretion scale (1996) provides a framework for grading secretion severity.

Purpose of the Study:

  • To validate the Murray secretion scale for assessing oropharyngeal dysphagia.
  • To evaluate the intra-rater and inter-rater reliability of the scale.
  • To determine the concurrent validity of the scale against expert clinical judgment.

Main Methods:

  • Two expert clinicians established a reference standard using 40 video recordings of fiberendoscopic swallowing evaluations (FSEs).
  • Four ENT residents independently rated and rerated the videos (10 per severity grade) in a blinded manner over a 4-week interval.
  • Statistical analysis included Kendall's tau (τ) for intra-rater reliability and Kendall's W for inter-rater reliability, and correlation with the reference standard.

Main Results:

  • Excellent intra-rater reliability was observed (Kendall's τ > 0.847, p < 0.001).
  • Exceptional inter-rater reliability was achieved (Kendall's W > 0.951, p < 0.001).
  • High correlation between median ratings and the reference standard (τ = 0.984, p < 0.001) indicates strong concurrent validity.

Conclusions:

  • The Murray secretion scale is a reliable and valid instrument for grading secretion severity in patients with oropharyngeal dysphagia.
  • The scale is recommended as an evidence-based tool for standardized fiberoptic endoscopic evaluation of swallowing (FEES).
  • Validated assessment tools improve diagnostic accuracy and guide therapeutic strategies for dysphagia management.