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Scoring the Penetration–Aspiration Scale (PAS) in Two Conditions: A Reliability Study

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Abstract

A widely applied metric for identifying airway invasion events is the Penetration–Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.

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Acknowledgements

The authors thank the speech-language pathologists and graduate students for their participation and dedication through this project. They are (in alphabetical order) Priscilla Brown, Mackenzie Chalifoux, Latoya Chisholm, Melissa Cooke, Mackenzie James, Keeley McKelvey, Cristina Perez, Stephanie Sandacz, Claire Scavone, Kellyanna Young, and Leslie Wilfong. The authors also acknowledge Kent Armeson for his contributions to the statistical analyses.

Funding

This study was supported by the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health (NIH/NIDCD 2K24DC012801-0).

Author information

Authors and Affiliations

  1. Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA

    Munirah Alkhuwaiter, Theresa Hopkins-Rossabi & Bonnie Martin-Harris

  2. Department of Otolaryngology–Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA

    Kate Davidson

  3. Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, USA

    Bonnie Martin-Harris

Authors
  1. Munirah Alkhuwaiter
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Correspondence to Munirah Alkhuwaiter.

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Conflicts of interest

Dr. Martin-Harris and Ms. Kate Davidson report grants from NIH/NIDCD, during the conduct of the study; royalties from Northern Speech Services through Medical University of South Carolina Foundation for Research Development, outside the submitted work. In addition, Dr. Martin-Harris has a patent US 62/710,324 issued. Dr. Theresa Hopkins-Rossabi and Ms. Alkhuwaiter have nothing to disclose.

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Northwestern University Institutional Review Board determined that the proposed study was exempt from human subject review (IRB ID: STU00207458).

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Appendix

Appendix

See Table 9.

Table 9 PAS scoring guidelines and operational definitions
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Alkhuwaiter, M., Davidson, K., Hopkins-Rossabi, T. et al. Scoring the Penetration–Aspiration Scale (PAS) in Two Conditions: A Reliability Study. Dysphagia 37, 407–416 (2022). https://doi.org/10.1007/s00455-021-10292-6

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