Hutcheson et al evaluated the ability of a patient to swallow after cancer therapy using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). This can help to identify a patient at risk for serious complications over time. The authors are from multiple institutions in the United States and England.
Subscales:
(1) efficiency of swallowing
(2) safety of swallowing
Types of test bolus:
(1) cracker or cooking
(2) pudding
(3) water
Grades of swallowing difficulty:
(0) none
(1) mild
(2) moderate
(3) severe
(4) life-threatening
|
Maximum Percent of Pharyngeal Residue |
Efficiency Level |
|
< 10% |
1 |
|
10 to 49% |
2 |
|
50 to 90% |
3 |
|
> 90% |
4 |
|
Efficiency Levels for All 3 Tests |
Efficiency Grade |
|
all level 1 |
0 |
|
any level 2, none 3 or 4 |
1 |
|
cracker/cookie level 3, other <= 2 |
2 |
|
liquid and/or pudding level 3, cracker or cookie level <= 3 |
3 |
|
one or two tests level 4 |
3 |
|
all tests level 4 |
4 |
The aspiration level is determined for each test bolus.
|
Status |
Safety Level |
|
neither penetration nor aspiration |
0 |
|
silent penetration above TVF (true vocal fold) |
1 |
|
flash penetration to TVF |
1 |
|
silent penetration to TVF, single event, trace amount |
1 |
|
silent penetration to TVF, intermittent or chronic |
2 |
|
flash aspiration, single event |
1 |
|
flash aspiration, chronic or intermittent |
2 |
|
aspiration not cleared, single event, not gross |
1 |
|
aspiration not cleared, intermittent, not cross |
2 |
|
aspiration not cleared, chronic but not gross |
3 |
|
aspiration not cleared, gross but not chronic |
3 |
|
aspiration not cleared, chronic and gross |
4 |
safety grade = MAX(safety level for all 3 test boli)
|
Efficiency Grade |
Safety Grade |
Overall Grade |
|
0 |
0 |
0 |
|
0 |
1 |
1 |
|
0 |
2 |
2 |
|
0 |
3 |
3 |
|
0 |
4 |
3 |
|
1 |
0 |
1 |
|
1 |
1 |
1 |
|
1 |
2 |
2 |
|
1 |
3 |
3 |
|
1 |
4 |
3 |
|
2 |
0 |
1 |
|
2 |
1 |
2 |
|
2 |
2 |
2 |
|
2 |
3 |
3 |
|
2 |
4 |
3 |
|
3 |
0 |
2 |
|
3 |
1 |
2 |
|
3 |
2 |
3 |
|
3 |
3 |
3 |
|
3 |
4 |
4 |
|
4 |
0 |
3 |
|
4 |
1 |
3 |
|
4 |
2 |
3 |
|
4 |
3 |
4 |
|
4 |
4 |
4 |
Specialty: Hematology Oncology
