title: Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.
abstract: OBJECTIVE
  To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method.
  
  
  METHODS
  Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by "white-out" following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets.
  
  
  RESULTS
  One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91).
  
  
  CONCLUSIONS
  The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Torao
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Horiuchi
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Makino
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kajiyama
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hyodo
keywords: Dysphagia; Endoscopy; Percutaneous endoscopic gastrostomy; Pureed diets