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Characterizing the Validity of Using VASES to Derive DIGEST-FEES Grades
James A Curtis1, Lauren Tabor Gray2, Loni Arrese3
1Aerodigestive Innovations Research Lab (AIR), Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, Cornell University, New York, New York, USA.
Summary
This study found substantial agreement between the Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) grading methods. Using VASES to derive DIGEST-FEES grades maintains construct validity, enhancing transparency and standardization.
Area of Science:
- Clinical assessment of swallowing disorders
- Flexible endoscopic evaluation of swallowing (FEES)
- Dysphagia diagnostics
Background:
- Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are complementary FEES assessment methods.
- VASES focuses on trial-level ratings (residue, penetration, aspiration), while DIGEST-FEES provides protocol-level impairment grades (safety, efficiency).
- The study aimed to validate the use of VASES for deriving DIGEST-FEES impairment grades.
Purpose of the Study:
- To assess the validity of deriving DIGEST-FEES impairment grades using the VASES method.
- To determine the level of agreement between original DIGEST-FEES grades and VASES-derived DIGEST-FEES grades.
- To evaluate if VASES-derived DIGEST-FEES grades maintain established construct validity.
Main Methods:
- Fifty Flexible Endoscopic Evaluation of Swallowing (FEES) procedures were analyzed.
- DIGEST-FEES grades were initially determined using the original method and subsequently derived using the VASES method by blinded analysts.
- Weighted Kappa (κw) and absolute agreement were used to compare grading methods; Spearman's correlations assessed construct validity.
Main Results:
- Substantial agreement (κw = 0.76-0.83) was found between original and VASES-derived DIGEST-FEES grades.
- Exact grade matches occurred in 60-62% of cases, with 92-100% within one grade difference.
- VASES-derived DIGEST-FEES grades showed similar construct validity correlations (r = 0.34-0.78) compared to original grades (r = 0.34-0.83).
Conclusions:
- Significant agreement exists between original DIGEST-FEES grades and those derived using VASES.
- Employing VASES to derive DIGEST-FEES grades preserves the method's construct validity.
- VASES offers a potential tool for enhancing the transparency and standardization of DIGEST-FEES ratings in clinical practice and research.
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