A Comment on “Aspiration Risk after Stroke: Comparison of Clinical Examination and Fiberoptic Endoscopic Evaluation of Swallowing” (Dysphagia 17:214–218, 2002)
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Working as a speech therapist in a neurology department, I have read the article by Leder and Espinosa  with great interest. I agree with Dr. Leder and his colleague that “visualization allows for accurate diagnostic information” and that instrumental evaluations should be used when easily available. The focus of their study, however, is not entirely clear because the concepts of “screening” and “examination” seem to have been confused. First, the purpose of a validation study is to determine the diagnostic value of an index test or screening against a reference test or “gold standard” . Therefore, the authors’ conclusion that FEES is a more adequate diagnostic instrument than clinical bedside testing is redundant. Second, it is not made clear why the authors did not compare the diagnostic values with those of the original study by Daniels et al. . In terms of likelihood ratio , the screening is practically worthless with a positive likelihood ratio of 1.2 and a negative...
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