Mapping the DIGEST Decision Tree to the IDDSI Framework to Promote Reproducibility and Global Implementation.

Area of Science:

• Medical Imaging
• Speech-Language Pathology
• Gastroenterology

Background:

• The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is an established tool for assessing pharyngeal swallowing function using radiographic and endoscopic data.
• DIGEST categorizes dysphagia severity (grades 0-4) based on penetration/aspiration and residue patterns across various food and liquid consistencies.
• The original DIGEST decision tree utilized generic terms for bolus types and consistencies, potentially limiting standardization.

Purpose of the Study:

• To map the existing DIGEST decision tree terminology to the standardized International Dysphagia Diet Standardisation Initiative (IDDSI) framework.
• To enhance the clinical implementation and reproducibility of the DIGEST tool by providing clear, standardized descriptors for bolus types and consistencies.

Main Methods:

• A commentary analyzing the DIGEST decision tree.
• Mapping generic bolus descriptors within the DIGEST tool to specific IDDSI diet and texture levels.
• Clarifying the relationship between DIGEST parameters and IDDSI terminology.

Main Results:

• The study successfully mapped the DIGEST decision tree to IDDSI terminology, providing a standardized reference.
• This mapping clarifies ambiguities in the original DIGEST descriptors for bolus types and consistencies.
• The proposed alignment facilitates consistent application of DIGEST across different clinical settings.

Conclusions:

• Aligning DIGEST with IDDSI terminology improves the precision and reproducibility of dysphagia grading.
• This standardization is crucial for consistent clinical implementation and research involving the DIGEST tool.
• The integration promotes better communication and understanding among healthcare professionals assessing swallowing function.