Evaluation of the Effectiveness of the Hyodo PA Score : A Modified Hyodo Score Incorporating the Severity of Liquid Penetration and Aspiration

Abstract

The Hyodo score is widely used as a standard evaluation method for videoendoscopic examination of swallowing (VE) in Japan, providing an objective and simple assessment of swallowing disorders. However, it does not adequately reflect the severity of the laryngeal penetration or aspiration. This study proposes the Hyodo-PA score, which incorporates penetration-aspiration evaluation based on the penetration-aspiration scale (PAS), into the Hyodo score and examines its clinical utility. We analyzed 223 patients with dysphagia to assess the correlation between the scoring systems and food consistency, as well as the accuracy of food consistency selection using an ROC analysis. The results showed that the Hyodo-PA score had a stronger correlation with food consistency in comparison to the Hyodo score, particularly in determining the feasibility of oral intake. However, there was little difference between the two scores in predicting the suitability of semisolid diets. These findings suggest that an appropriate food consistency selection requires not only the integration of laryngeal penetration and aspiration severity into the Hyodo score, but also a comprehensive assessment incorporating VE findings of thickened liquid and jelly swallowing, as well as general conditions such as consciousness level, cognitive function, and nutritional status. Further studies are needed to establish an optimal approach to integrate these factors into clinical practice.