The dysphagia outcome and severity scale

The Dysphagia Outcome and Severity Scale (DOSS) is a simple, easy-to-use, 7 -point scale developed to systematically rate the functional severity of dy sphagia based an objective assessment and make recommendations for diet lev el, independence level, and type of nutrition. Intra- and interjudge reliab ilities of the DOSS was established by four clinicians on 135 consecutive p atients who underwent a modified barium swallow procedure at a large teachi ng hospital. Patients were assigned a severity level, independence level, a nd nutritional level based on three areas most associated with final recomm endations: oral stage bolus transfer, pharyngeal stage retention, and airwa y protection. Results indicate high interrater (90%) and intrarater (93%) a greement with this scale. Implications are suggested for use of the DOSS in documenting functional outcomes of swallowing and diet status based on obj ective assessment.