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

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.

The FEES box: A novel barrier to contain particles during aerosol-generating procedures.

PURPOSE: Due to the COVID-19 pandemic, aerosol-generating procedures (AGPs) such as flexible endoscopic evaluation of swallowing (FEES) have been deemed high-risk and in some cases restricted, indicating the need for additional personal protective equipment. The aim of this study was to erect and study a protective barrier for FEES. MATERIALS AND METHODS: A PVC cube was constructed to fit over a patient while allowing for upright endoscopy. A plastic drape was fitted over the cube, and the protective barrier was subsequently named the "FEES Box." Three different particulate-generating tasks were carried out: sneezing, coughing, and spraying water from an atomizer bottle. Each task was completed within and without the FEES Box, and particulate was measured with a particle counter. The average particles/L detected during the three tasks, and baseline measurements, were statistically compared. RESULTS: Without the FEES Box in place, the sneezing and spraying tasks resulted in a statistically significant increase in particles above baseline (p < 0.001 and p = 0.004, respectively); coughing particulate never reached levels significantly higher than baseline (p = 0.230). With use of the FEES Box, there was no statistically significant increase in particles above baseline in any of the three tasks. CONCLUSION: The FEES Box effectively contained particles generated during sneezes and an atomizer spray. It would also likely mitigate coughing particulate, but coughing did not generate a significant increase in particles above baseline. Further research is warranted to test the efficacy of the FEES Box in containing particulate matter during a complete FEES procedure.

Inter- and Intra-Rater Reliability of Laryngeal Sensation Testing with the Touch Method During Flexible Endoscopic Evaluations of Swallowing.

OBJECTIVES: Sensation is an integral component of laryngeal control for breathing, swallowing, and vocalization. Laryngeal sensation is assessed by elicitation of the laryngeal adductor reflex (LAR), a brainstem-mediated adduction of the true vocal folds. During Flexible Endoscopic Evaluations of Swallowing (FEES), the touch method can be used to elicit the LAR to judge laryngeal sensation. Despite the prevalence of this method in clinical practice and research, prior studies have yet to examine inter- and intra-rater reliability. METHODS: Four speech-language pathologists rated 125 randomized video clips for the presence, absence, or inability to rate the LAR. Fifty percent of video clips were re-randomized and re-rated 1 week later. Raters then created guidelines and participated in formal consensus training sessions on a separate set of videos. Ratings were repeated post-training. RESULTS: Overall inter-rater reliability was fair (κ = 0.22) prior to training. Pre-training intra-rater reliability ranged from fair (κ = 0.35) to almost perfect (κ = 0.89). Inter-rater reliability significantly improved after training (κ = 0.42, P < .001), though agreement did not reach prespecified acceptable levels (κ ≥ 0.80). Post-training intra-rater reliability ranged from moderate (κ = 0.49) to almost perfect (κ = 0.85). CONCLUSION: Adequate inter-rater reliability was not achieved when rating isolated attempts to elicit the LAR. Acceptable within-rater reliability was observed in some raters 1 week after initial ratings, suggesting that ratings may remain consistent within raters over a short period of time. Limitations and considerations for future research using the touch method are discussed.