Dysphagia Outcome and Severity Scale

The Dysphagia Outcome and Severity Scale (DOSS) is a 7-point clinician-rated ordinal scale that measures the severity of swallowing dysfunction and functional swallowing outcomes across two dimensions: safety (penetration-aspiration risk) and efficiency (oral intake adequacy and diet level tolerance). Developed by O'Neil and colleagues in 1999, DOSS integrates clinical observation with videofluoroscopic findings to provide a standardized, functionally meaningful classification of swallowing status from normal to non-functional.