Reliability and validity of the DEFISS score for predicting post-extubation dysphagia and dysphagia-related reintubation after stroke

Post-extubation dysphagia is frequent after severe stroke and can lead to pneumonia, delayed recovery, and dysphagia-related reintubation. We evaluated the Determine Extubation Failure in Severe Stroke (DEFISS) score, a bedside tool combining stroke-specific clinical factors, duration of mechanical ventilation, and a brief oral motor function assessment to support pre-extubation risk stratification. In a prospective single-center cohort, three blinded raters (novice, intermediate, expert) independently scored DEFISS immediately before planned extubation, which followed routine clinical care. After extubation, all patients underwent flexible endoscopic evaluation of swallowing by assessors blinded to DEFISS. The primary outcome was dysphagia-related reintubation within 120 h, and construct validity was assessed against the Fiberoptic Endoscopic Dysphagia Severity Scale. Thirty-nine stroke patients (mean age 73.9 ± 11.6 years; 54% female) were included; five (12.8%) experienced dysphagia-related reintubation. Interrater reliability was excellent (ICC_single 0.887; ICC_average 0.959), with similarly high reliability for the oral motor function component (ICC_single 0.874). DEFISS correlated with endoscopic dysphagia severity (ρ = 0.44, p = 0.005). Using a prespecified cutoff (DEFISS ≥ 4), odds of dysphagia-related reintubation increased (OR 11.1, p = 0.035) with sensitivity 0.80 and specificity 0.73. DEFISS may provide a pragmatic triage tool to prioritize early FEES and targeted dysphagia management in critically ill stroke patients.