**Author details**

dichotomization, the P-SCA score recognizes more patients at risk, resulting more sensitive

In conclusion, the assessment of patients with deglutition disorders has to consider as many elements as are available from the clinical and instrumental evaluation (integrated clinical

The possibility of an instrumental evaluation sharpens the diagnostic precision with margins of error that vary for every procedure, but with the possibility of over estimating the risk of aspiration. In fact, patients with higher risk according to the P-score are attributed by P-SCA score to lower risk categories. Both have a high sensibility to individualize patients with a risk of inhalation from minimum to high. Nevertheless, the P-score is more specific, more skilled in recognizing the false positive and therefore more reliable in correctly classifying patients

In other words, while in patients considered without risk by the P-score, the clinical variable considered by the P-SCA-score increases the evaluation of the risk, in patients classified by Pscore in the categories of higher severity, the evaluation of such clinical variables tends to mitigate the judgement expressed by the P-score and to put back patients into the categories

The association of endoscopy and elements of the CSE in the evaluation of the severity of dysphagia, tends to mitigate the gravity of the clinical case, allowing a more careful estimate

The first consideration is that a criterion of severity must be a complete clinical criterion, which considers as many elements as possible from the clinical non-instrumental and instrumental evaluation. In general, any event leading the team to modify the treatment programme already decided, can become element of severity. As previously said, the only CSE, however well conducted, may underestimate the severity of a swallowing disorder in relation to the inability to directly see the effectors of swallowing and their behavior during the passage of the bolus. The contribution of the instrumental examination, in this issue, is essential: It shows the clinicians what happens inside the effectors during the passage of the bolus, but it tends to overestimate the severity of the disorder, inducing in the risk of generalization of patterns that

The endoscopic examination is a versatile and well-tolerated tool, which promptly facilitates and ratifies the team's activities. The latest developments of the endoscopic investigation with the possibility of a direct visualization of the oral (O-FEES) and the esophageal (E-FEES) phase of swallowing makes FEES more complete and brings it closer to the radiological gold

than the P-score, but also less specific (more false positive).

without dysphagia and patients with a risk of any degree of dysphagia.

evaluation).

86 Seminars in Dysphagia

with lower risk.

**8. Conclusions**

standard.

in a routine clinical context.

In conclusion, some observations can be made.

may not reflect the real functional status of the effectors.

Farneti Daniele1\* and Genovese Elisabetta2

\*Address all correspondence to: lele\_doc@libero.it

1 Audiology and Phoniatry Service, AUSL of Romagna - Infermi Hospital – Rimini, Italy

2 Audiology Service, University of Modena - Reggio Emilia, Modena, Italy
