{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T17:55:13Z","timestamp":1781373313135,"version":"3.54.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007210","name":"RWTH Aachen University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007210","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Multi-consistency testing during flexible endoscopic evaluation of swallowing (FEES) is clinically necessary, but introduces selection bias: worst scores inflate severity because the number of consistencies tested covaries with disease severity. In this retrospective observational study of hospitalized neurological patients, we derived and validated the FEES Dysphagia Index (FDI) in two temporally independent cohorts (Cohort 1: 2013\u20132018,\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u20091,257; Cohort 2: 2021\u20132025,\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u20091,686) from a single center. FDI-S averages Penetration\u2013Aspiration Scale (PAS) scores across tested consistencies (0\u2013100 scale); FDI-E uses Yale Pharyngeal Residue scores; FDI-C combines both. Selection bias was quantified using sequential branching-tree inverse probability weighting (IPW). Worst PAS overestimated severity by 24%; FDI deviated by\u2009&lt;\u20092%. FDI-C was significantly superior to Worst PAS for hospital-acquired pneumonia (HAP; AUC 0.70 vs. 0.60,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), mortality (0.71 vs. 0.62,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.040), and restricted oral intake (0.90 vs. 0.74,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and statistically equivalent to clinician-rated severity. FDI-C mapped linearly onto ordinal Functional Oral Intake Scale values (FOIS; proportional odds RCS\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.99). With functional status and diagnosis, FDI-C reconstructed the clinician's oral intake recommendation with AUC up to 0.93. The FDI-C-mortality relationship was sigmoidal with a clinically relevant transition zone between\u2009~\u200950 and\u2009~\u200985. FDI-C is a bias-resilient, bedside-calculable score with interval-scale properties that captures expert clinical judgment, suitable as both a clinical decision support tool and a continuous research endpoint.\n                  <\/jats:p>","DOI":"10.1007\/s00415-026-13895-x","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:33:13Z","timestamp":1780464793000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The FEES Dysphagia Index: a bias-resilient continuous score that captures expert clinical judgment in 2,943 neurological inpatients"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4624-7995","authenticated-orcid":false,"given":"Cornelius J.","family":"Werner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0320-5207","authenticated-orcid":false,"given":"Elizabet","family":"Sanchez-Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Mall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6904-7152","authenticated-orcid":false,"given":"Tareq","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3977-7146","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Pinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8903-0593","authenticated-orcid":false,"given":"Joerg B.","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3530-5766","authenticated-orcid":false,"given":"Beate","family":"Schumann-Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"13895_CR1","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/BF02414429","volume":"2","author":"SE Langmore","year":"1988","unstructured":"Langmore SE, Kenneth SMA, Olsen N (1988) Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2:216\u2013219. https:\/\/doi.org\/10.1007\/BF02414429","journal-title":"Dysphagia"},{"key":"13895_CR2","doi-asserted-by":"publisher","DOI":"10.1038\/gimo28","author":"SE Langmore","year":"2006","unstructured":"Langmore SE (2006) Endoscopic evaluation of oral and pharyngeal phases of swallowing. GI Motil Online. https:\/\/doi.org\/10.1038\/gimo28","journal-title":"GI Motil Online"},{"key":"13895_CR3","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s12909-016-0587-3","volume":"16","author":"R Dziewas","year":"2016","unstructured":"Dziewas R, Glahn J, Helfer C et al (2016) Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Med Educ 16:70. https:\/\/doi.org\/10.1186\/s12909-016-0587-3","journal-title":"BMC Med Educ"},{"key":"13895_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-024-00321-8","volume":"6","author":"R Dziewas","year":"2024","unstructured":"Dziewas R, Warnecke T, Labeit B et al (2024) Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia\u2013 towards an integrated FEES report. Neurol Res Pract 6:26. https:\/\/doi.org\/10.1186\/s42466-024-00321-8","journal-title":"Neurol Res Pract"},{"key":"13895_CR5","doi-asserted-by":"publisher","first-page":"LXXXIX","DOI":"10.1177\/23969873211039721","volume":"6","author":"R Dziewas","year":"2021","unstructured":"Dziewas R, Michou E, Trapl-Grundschober M et al (2021) European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 6:LXXXIX\u2013CXV. https:\/\/doi.org\/10.1177\/23969873211039721","journal-title":"Eur Stroke J"},{"key":"13895_CR6","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00417897","volume":"11","author":"JC Rosenbek","year":"1996","unstructured":"Rosenbek JC, Robbins JA, Roecker EB et al (1996) A Penetration\u2013Aspiration Scale. Dysphagia 11:93\u201398. https:\/\/doi.org\/10.1007\/BF00417897","journal-title":"Dysphagia"},{"key":"13895_CR7","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s00455-017-9809-z","volume":"32","author":"CM Steele","year":"2017","unstructured":"Steele CM, Grace-Martin K (2017) Reflections on clinical and statistical use of the Penetration\u2013Aspiration Scale. Dysphagia 32:601\u2013616. https:\/\/doi.org\/10.1007\/s00455-017-9809-z","journal-title":"Dysphagia"},{"key":"13895_CR8","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00455-019-10064-3","volume":"35","author":"JC Borders","year":"2020","unstructured":"Borders JC, Brates D (2020) Use of the Penetration\u2013Aspiration Scale in dysphagia research: a systematic review. Dysphagia 35:583\u2013597. https:\/\/doi.org\/10.1007\/s00455-019-10064-3","journal-title":"Dysphagia"},{"key":"13895_CR9","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2024.1337971","author":"JC Borders","year":"2024","unstructured":"Borders JC, Steele CM (2024) The effect of liquid consistency on penetration-aspiration: a Bayesian analysis of two large datasets. Front Rehabil Sci. https:\/\/doi.org\/10.3389\/fresc.2024.1337971","journal-title":"Front Rehabil Sci"},{"key":"13895_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s00115-021-01127-8","author":"A Wehner","year":"2021","unstructured":"Wehner A, Schumann-Werner B, Fimm B et al (2021) Standards in the use of fiberoptic endoscopic evaluation of swallowing in Germany: a questionnaire survey. Nervenarzt. https:\/\/doi.org\/10.1007\/s00115-021-01127-8","journal-title":"Nervenarzt"},{"key":"13895_CR11","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s00455-024-10738-7","volume":"40","author":"JC Borders","year":"2025","unstructured":"Borders JC, Grande AA, Barbon CEA et al (2025) Effects of statistical practices for longitudinal group comparison of the Penetration\u2013Aspiration Scale on power and effect size estimation: a Monte Carlo simulation study. Dysphagia 40:388\u2013398. https:\/\/doi.org\/10.1007\/s00455-024-10738-7","journal-title":"Dysphagia"},{"key":"13895_CR12","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1044\/2021_JSLHR-21-00014","volume":"64","author":"HM Starmer","year":"2021","unstructured":"Starmer HM, Arrese L, Langmore S et al (2021) Adaptation and validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES. J Speech Lang Hear Res 64:1802\u20131810. https:\/\/doi.org\/10.1044\/2021_JSLHR-21-00014","journal-title":"J Speech Lang Hear Res"},{"key":"13895_CR13","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-023-10650-6","author":"B Labeit","year":"2023","unstructured":"Labeit B, Lapa S, Muhle P et al (2023) Validation of the DIGEST-FEES as a global outcome measure for pharyngeal dysphagia in Parkinson\u2019s Disease. Dysphagia. https:\/\/doi.org\/10.1007\/s00455-023-10650-6","journal-title":"Dysphagia"},{"key":"13895_CR14","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1159\/000228711","volume":"28","author":"T Warnecke","year":"2009","unstructured":"Warnecke T, Ritter MA, Kr\u00f6ger B et al (2009) Fiberoptic Endoscopic Dysphagia Severity Scale predicts outcome after acute stroke. CED 28:283\u2013289. https:\/\/doi.org\/10.1159\/000228711","journal-title":"CED"},{"key":"13895_CR15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1159\/000135652","volume":"26","author":"R Dziewas","year":"2008","unstructured":"Dziewas R, Warnecke T, \u00d6lenberg S et al (2008) Towards a basic endoscopic assessment of swallowing in acute stroke \u2013 development and evaluation of a simple dysphagia score. CED 26:41\u201347. https:\/\/doi.org\/10.1159\/000135652","journal-title":"CED"},{"key":"13895_CR16","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1002\/mds.23060","volume":"25","author":"T Warnecke","year":"2010","unstructured":"Warnecke T, Oelenberg S, Teismann I et al (2010) Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov Disord 25:1239\u20131245. https:\/\/doi.org\/10.1002\/mds.23060","journal-title":"Mov Disord"},{"key":"13895_CR17","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/mus.26377","volume":"59","author":"JB Schr\u00f6der","year":"2019","unstructured":"Schr\u00f6der JB, Marian T, Muhle P et al (2019) Intubation, tracheostomy, and decannulation in patients with Guillain\u2013Barr\u00e9\u2013syndrome\u2014does dysphagia matter? Muscle Nerve 59:194\u2013200. https:\/\/doi.org\/10.1002\/mus.26377","journal-title":"Muscle Nerve"},{"key":"13895_CR18","doi-asserted-by":"publisher","DOI":"10.1177\/17562864211035544","volume":"14","author":"T Warnecke","year":"2021","unstructured":"Warnecke T, Im S, Labeit B et al (2021) Detecting myasthenia gravis as a cause of unclear dysphagia with an endoscopic Tensilon test. Ther Adv Neurol Disord 14:17562864211035544. https:\/\/doi.org\/10.1177\/17562864211035544","journal-title":"Ther Adv Neurol Disord"},{"key":"13895_CR19","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1002\/acn3.51099","volume":"7","author":"S Lapa","year":"2020","unstructured":"Lapa S, Claus I, Reitz SC et al (2020) Effect of thalamic deep brain stimulation on swallowing in patients with essential tremor. Ann Clin Transl Neurol 7:1174\u20131180. https:\/\/doi.org\/10.1002\/acn3.51099","journal-title":"Ann Clin Transl Neurol"},{"key":"13895_CR20","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s00455-015-9631-4","volume":"30","author":"PD Neubauer","year":"2015","unstructured":"Neubauer PD, Rademaker AW, Leder SB (2015) The Yale Pharyngeal Residue Severity Rating Scale: an anatomically defined and image-based tool. Dysphagia 30:521\u2013528. https:\/\/doi.org\/10.1007\/s00455-015-9631-4","journal-title":"Dysphagia"},{"key":"13895_CR21","doi-asserted-by":"publisher","first-page":"2505","DOI":"10.1177\/0962280215601134","volume":"26","author":"PC Austin","year":"2017","unstructured":"Austin PC, Stuart EA (2017) Estimating the effect of treatment on binary outcomes using full matching on the propensity score. Stat Methods Med Res 26:2505\u20132525. https:\/\/doi.org\/10.1177\/0962280215601134","journal-title":"Stat Methods Med Res"},{"key":"13895_CR22","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1016\/S0140-6736(18)30668-8","volume":"391","author":"T Gilbert","year":"2018","unstructured":"Gilbert T, Neuburger J, Kraindler J et al (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 391:1775\u20131782. https:\/\/doi.org\/10.1016\/S0140-6736(18)30668-8","journal-title":"Lancet"},{"key":"13895_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0214194","volume":"14","author":"D Koch","year":"2019","unstructured":"Koch D, Schuetz P, Haubitz S et al (2019) Improving the post-acute care discharge score (PACD) by adding patients\u2019 self-care abilities: a prospective cohort study. PLoS ONE 14:e0214194. https:\/\/doi.org\/10.1371\/journal.pone.0214194","journal-title":"PLoS ONE"},{"key":"13895_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2020.151274","volume":"54","author":"D Koch","year":"2020","unstructured":"Koch D, Kutz A, Haubitz S et al (2020) Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: a prospective cohort study. Appl Nurs Res 54:151274. https:\/\/doi.org\/10.1016\/j.apnr.2020.151274","journal-title":"Appl Nurs Res"},{"key":"13895_CR25","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","volume":"44","author":"ER DeLong","year":"1988","unstructured":"DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837\u2013845","journal-title":"Biometrics"},{"key":"13895_CR26","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1002\/sim.2331","volume":"25","author":"P Royston","year":"2006","unstructured":"Royston P, Altman DG, Sauerbrei W (2006) Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 25:127\u2013141. https:\/\/doi.org\/10.1002\/sim.2331","journal-title":"Stat Med"},{"key":"13895_CR27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7549.1080","volume":"332","author":"DG Altman","year":"2006","unstructured":"Altman DG, Royston P (2006) The cost of dichotomising continuous variables. BMJ 332:1080.1. https:\/\/doi.org\/10.1136\/bmj.332.7549.1080","journal-title":"BMJ"},{"key":"13895_CR28","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","volume":"49","author":"P Peduzzi","year":"1996","unstructured":"Peduzzi P, Concato J, Kemper E et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373\u20131379. https:\/\/doi.org\/10.1016\/S0895-4356(96)00236-3","journal-title":"J Clin Epidemiol"},{"key":"13895_CR29","volume-title":"Psychometric theory","author":"JC Nunnally","year":"1994","unstructured":"Nunnally JC, Bernstein IH (1994) Psychometric theory, 3rd ed. McGraw-Hill, New York","edition":"3rd ed"},{"key":"13895_CR30","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1177\/0003489414566267","volume":"124","author":"SG Butler","year":"2015","unstructured":"Butler SG, Markley L, Sanders B et al (2015) Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol 124:480\u2013483. https:\/\/doi.org\/10.1177\/0003489414566267","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"13895_CR31","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s00455-018-9883-x","volume":"33","author":"JM Pisegna","year":"2018","unstructured":"Pisegna JM, Borders JC, Kaneoka A et al (2018) Reliability of untrained and experienced raters on FEES: rating overall residue is a simple task. Dysphagia 33:645\u2013654. https:\/\/doi.org\/10.1007\/s00455-018-9883-x","journal-title":"Dysphagia"},{"key":"13895_CR32","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing 2021."},{"key":"13895_CR33","doi-asserted-by":"publisher","DOI":"10.1002\/0471722162","volume-title":"Order statistics","author":"HA David","year":"2003","unstructured":"David HA, Nagaraja HN (2003) Order statistics, 1st ed. Wiley. https:\/\/doi.org\/10.1002\/0471722162","edition":"1st ed"},{"key":"13895_CR34","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/ana.25151","volume":"83","author":"S Suntrup-Krueger","year":"2018","unstructured":"Suntrup-Krueger S, Ringmaier C, Muhle P et al (2018) Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol 83:328\u2013340. https:\/\/doi.org\/10.1002\/ana.25151","journal-title":"Ann Neurol"},{"key":"13895_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurot.2025.e00613","volume":"22","author":"S Suntrup-Krueger","year":"2025","unstructured":"Suntrup-Krueger S, Labeit B, Von Itter J et al (2025) Treating postextubation dysphagia after stroke with pharyngeal electrical stimulation \u2013 insights from a randomized controlled pilot trial. Neurotherapeutics 22:e00613. https:\/\/doi.org\/10.1016\/j.neurot.2025.e00613","journal-title":"Neurotherapeutics"},{"key":"13895_CR36","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s00455-016-9758-y","volume":"32","author":"JAY Cichero","year":"2017","unstructured":"Cichero JAY, Lam P, Steele CM et al (2017) Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: The IDDSI framework. Dysphagia 32:293\u2013314. https:\/\/doi.org\/10.1007\/s00455-016-9758-y","journal-title":"Dysphagia"},{"key":"13895_CR37","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00455-014-9549-2","volume":"29","author":"LWJ Baijens","year":"2014","unstructured":"Baijens LWJ, Speyer R, Pilz W et al (2014) FEES protocol derived estimates of sensitivity: Aspiration in dysphagic patients. Dysphagia 29:583\u2013590. https:\/\/doi.org\/10.1007\/s00455-014-9549-2","journal-title":"Dysphagia"},{"key":"13895_CR38","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s00455-008-9185-9","volume":"23","author":"B Martin-Harris","year":"2008","unstructured":"Martin-Harris B, Brodsky MB, Michel Y et al (2008) MBS measurement tool for swallow impairment\u2014MBSImp: Establishing a standard. Dysphagia 23:392\u2013405. https:\/\/doi.org\/10.1007\/s00455-008-9185-9","journal-title":"Dysphagia"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13895-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13895-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13895-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T17:09:57Z","timestamp":1781370597000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13895-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["13895"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13895-x","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"20 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This study was approved by the ethics committee of RWTH Aachen University (EK 088\/17) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Individual informed consent was waived by the ethics committee due to the retrospective design and the exclusive use of routinely collected, pseudonymized clinical data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"359"}}