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

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is an evidence-based tool used to grade the results of radiographic and endoscopic evaluations of pharyngeal swallowing function. DIGEST uses a decision tree to derive dysphagia grades (0 = normal, 1 = mild, 2 = moderate, 3 = severe, 4 = profound/life threatening) based on patterns of penetration/aspiration and residue events over different bolus types (e.g., liquid, pudding, solid) and consistencies (e.g., thin or thick liquid). Generic terminology was used to describe bolus types and consistencies in the original DIGEST decision tree. In this commentary, the investigators map the DIGEST decision tree to the International Dysphagia Diet Standardisation Initiative (IDDSI) terminology. The goal of this work is to promote reproducibility in clinical implementation of DIGEST by clarifying the original generic descriptors of bolus type/consistency with the IDDSI terminology.