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Confidence, Accuracy, and Reliability of Penetration-Aspiration Scale Ratings on Flexible Endoscopic Evaluations of Swallowing by Speech Pathologists

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Abstract

This study investigated rater confidence when rating airway invasion with the penetration-aspiration scale (PAS) on flexible endoscopic evaluations of swallowing (FEES), raters’ accuracy against a referent-standard, inter-rater reliability, and potential associations between clinician confidence, experience, and accuracy. Thirty-one clinicians who use FEES in their daily practice were asked to judge airway invasion with the PAS and to rate their confidence that their score was correct (0–100) for 40 video clips, five in each of the 8 PAS categories. We found that raters were most confident in rating PAS 1, 7, and 8. The average confidence score across all videos was 76/100. Confidence did not have a significant relationship with accuracy against the referent-standard. Accuracy was highest for PAS 1 (92%), followed by PAS 8 (80%), PAS 7 (77%), and PAS 4 (72%). Accuracy was below 60% for PAS 2, 3, 5, and 6, the lowest being for PAS 3 (49%). Mean accuracy for all ratings, compared to referent-standard ratings, was highest for the intermediate group (71%), followed by expert (68%) and novice (65%). In general, we found that certain PAS scores tend to be rated more accurately, and that participating SLPs had varied confidence in PAS ratings on FEES. Potential reasons for these findings as well as suggested next steps are discussed.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors received no financial support for this research study.

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Authors and Affiliations

  1. Boston Medical Center, Boston, MA, USA

    Merertu Kitila, Gintas P. Krisciunas, Edel McNally & Jessica M. Pisegna

  2. George Washington University Hospital, Washington, DC, USA

    Merertu Kitila

  3. Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA

    James C. Borders

  4. Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA

    Gintas P. Krisciunas & Jessica M. Pisegna

  5. Department of Speech Language Pathology, Sargent College, Boston University, Boston, MA, USA

    Jessica M. Pisegna

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  1. Merertu Kitila
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Correspondence to Jessica M. Pisegna.

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Salary support was provided to the authors from their respective institutions.

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Informed consent was obtained from all participants prior to enrollment in this research study.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was obtained from the Institutional Review Board.

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Kitila, M., Borders, J.C., Krisciunas, G.P. et al. Confidence, Accuracy, and Reliability of Penetration-Aspiration Scale Ratings on Flexible Endoscopic Evaluations of Swallowing by Speech Pathologists. Dysphagia (2023). https://doi.org/10.1007/s00455-023-10635-5

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