title: Validation of the secretion severity rating scale.
abstract: Accumulation of secretions within the hypopharynx, aditus laryngis, and trachea is one characteristic of severe dysphagia and is of high clinical and therapeutic relevance. For the graduation of the secretion severity level, a secretion scale was provided by Murray et al. in 1996. The purpose of the study presented here is the validation of this scale by analyzing the intra-rater and inter-rater reliability as well as concurrent validity. For examination of reliability and validity, a reference standard was defined by two expert clinicians who reviewed 40 video recordings of fiberendoscopic swallowing evaluations, with 10 videos for each severity grade. These videos were rated and rerated independently and blinded by 4 ENT-residents with an interval of 4 weeks. Both the intra-rater (Kendall's τ > 0.847***) and inter-rater reliability (Kendall's W > 0.951***) were highly significant and can be considered good or very good. Correlation of the median of all ratings with the reference standard was close to the highest possible value 1 (τ = 0.984***). The scale was proved to be a reliable and valid instrument for graduation of one of the principal symptoms of oropharyngeal dysphagia and is recommended as an evidence-based instrument for standardized fiberoptic endoscopic evaluation of swallowing.
authors.affiliation: Department of Phoniatrics and Pediatric Audiology, University Hospital of Marburg, Baldingerstr. 1, 35032, Marburg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Pluschinski
authors.affiliation: Department of Phoniatrics and Pediatric Audiology, University Hospital of Marburg, Baldingerstr. 1, 35032, Marburg, Germany.
authors.forename: Eugen
authors.initials: E
authors.lastname: Zaretsky
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Stöver
authors.affiliation: Audiology and Speech Pathology Service, VA Ann Arbor Healthcare System, Fuller Road 2215, 48105, Ann Arbor, MI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Murray
authors.affiliation: Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital of Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Sader
authors.affiliation: Department of Phoniatrics and Pediatric Audiology, University Hospital of Marburg, Baldingerstr. 1, 35032, Marburg, Germany. Christiane.Hey@med.uni-marburg.de.
authors.forename: Christiane
authors.initials: C
authors.lastname: Hey
mesh_terms: D003680:Deglutition Disorders / Q000175:diagnosis*; D004724:Endoscopy; D006801:Humans; D007013:Hypopharynx / Q000378:metabolism*; D007820:Laryngeal Mucosa / Q000378:metabolism*; D007830:Larynx / Q000378:metabolism; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014132:Trachea / Q000378:metabolism*; D014741:Video Recording
keywords: Dysphagia; FEES ®; Secretion scale; Swallowing disorder; Validity