Does the total dysphagia risk score correlate with swallowing function examined by videofluoroscopy?

OBJECTIVE: The purpose of this study was to correlate the total dysphagia risk score (TDRS) with swallowing function as measured by videofluoroscopy of swallowing using the swallowing performance scale (SPS) and the penetration aspiration scale (PAS).

METHODS: 63 patients from two different centres treated with radiotherapy for head and neck cancer were evaluated in the current study. Swallowing videofluoroscopies at baseline, 6 and 12 months following radiotherapy were evaluated by two observers. The TDRS of all patients was calculated and correlated with the consensus PAS and SPS scores of the two observers.

RESULTS: Regarding the PAS scale, we did not observe a significant correlation with the TDRS. Regarding SPS, we found a significant correlation at 6 months (p = 0.01) and a borderline significant correlation at 12 months (p = 0.05). We observed statistically lower SPS scores for patients in the intermediate-risk category when compared to the high-risk category. When we compared low vs high TDRS risk patients, we did not observe a significant difference regarding SPS scores. When comparing low- vs intermediate-risk patients, we observed higher SPS scores in the low-risk group (p = 0.01). When the low- and intermediate-risk patients were grouped together, we observed less swallowing problems as measured by SPS in the low and intermediate group when compared to the high-risk group (p = 0.05) at 6 months.

CONCLUSION: Patients with high-risk TDRS scores have higher SPS scores when compared to the intermediate group and the intermediate- and low-risk group together. However, low-risk patients in our patient cohort could not be distinguished from high or intermediate-risk patients. Advances in knowledge: TDRS was never correlated with videofluoroscopies in past studies. The hypothesis of this paper was to see if the TDRS could guide us to see which patients are at risk for high scores on SPS and PAS and might need a videofluoroscopic examination in the follow up. Given the poor correlations in our study, however, we cannot recommend the use of the TDRS to select patients who might benefit from the additional information provided by videofluoroscopies.