Clarification Request: Interpretation of itemid = 225118 Values (Dysphagia-Positive vs Risk/Precaution) and Whether the Dataset Captures Post-Consult Outcomes or Only the Initial Bedside Screen

[wang1780]

Dear MIMIC-IV community members,

I have a clarification question regarding the nursing workflow documented for chartevents itemid = 225118 ("Difficulty swallowing"). The workflow states: "If yes to any of the screening items: Obtain NPO order. No food or drink until a consult."
Specifically, I would like to clarify three points:

1. In how MIMIC-IV records "Difficulty swallowing," does obtaining an NPO order correspond to a dysphagia-positive classification in the dataset (i.e., value = 1), or is it best interpreted as a precaution/risk trigger pending specialist consultation?
2. For patients with a positive finding on any component of the initial bedside screen (e.g., altered alertness, inability to remain upright, oropharyngeal secretions, unstable breathing, or a history of dysphagia / thickened-liquid diet), does itemid = 225118 reflect dysphagia based on the initial nursing bedside screen alone? Or are these patients later assessed differently after the consult — such that the dataset may capture risk/precaution rather than confirmed dysphagia?
3. Does the dataset capture post-consult outcomes (e.g., whether the consultant subsequently permitted a water swallow screening, or confirmed/excluded dysphagia), or does itemid = 225118 only document the initial bedside screening result?

In other words: should itemid = 225118 be interpreted as a screening-based classification of suspected dysphagia, or as a confirmed diagnosis that incorporates specialist consultation?

Any clarification would be greatly appreciated, as it directly affects how we define the outcome in our MIMIC-IV cohort study.

Thank you.