MDADI as a Screening Tool for VFSS ‐Graded Swallowing Impairment in Head and Neck Cancer Patients

Vollständiger Abstract

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ABSTRACT Objectives To determine clinically useful MD Anderson Dysphagia Inventory (MDADI) thresholds associated with Videofluoroscopic swallow study (VFSS)‐graded swallowing impairment in head and neck cancer (HNC) patients and to explore whether a reduced‐item MDADI could preserve discrimination while minimizing patient burden. Methods This retrospective cross‐sectional study analyzed HNC patients from a prospectively maintained dysphagia surveillance program who completed the MDADI within 120 days of VFSS. Associations between MDADI and VFSS metrics were assessed using Spearman and point‐biserial correlations. Swallowing impairment was defined using Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and Penetration–Aspiration Scale (PAS) with clinically relevant dichotomization. Optimal MDADI composite score thresholds were derived using Youden's J statistic, and exploratory item reduction investigated the ability of a concise subset to preserve discrimination of clinically significant impairment. Results A total of 208 patients contributed 470 MDADI–VFSS observations for PAS and 443 for DIGEST (mean follow‐up 3.7 years and MDADI–VFSS interval 56 ± 35.9 days). MDADI composite scores showed moderately strong and moderate inverse correlations with DIGEST ( r = −0.63, p < 0.001) and PAS ( r = −0.50, p < 0.001), respectively, with good discrimination across both outcome definitions (AUC 0.78–0.88). Optimal MDADI thresholds ranged from 74 to 78 with ~74 best identifying DIGEST ≥ 2. A four‐item MDADI short form (F3, E3, E4, and P6) showed strong agreement with Composite score ( r = 0.96), with good discrimination of DIGEST‐defined impairment (AUC = 0.85). Conclusion MDADI scores correlate with VFSS‐graded impairment in HNC patients. A composite threshold near 74 may serve as a clinically useful screening parameter for identifying patients requiring swallowing evaluation. Level of Evidence 3.