Elsevier

The Journal of Pediatrics

Volume 201, October 2018, Pages 141-146
The Journal of Pediatrics

Original Articles
Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

https://doi.org/10.1016/j.jpeds.2018.05.030Get rights and content

Objectives

To determine if any presenting symptoms are associated with aspiration risk, and to evaluate the reliability of clinical feeding evaluation (CFE) in diagnosing aspiration compared with videofluoroscopic swallow study (VFSS).

Study design

We retrospectively reviewed records of children under 2 years of age who had evaluation for oropharyngeal dysphagia by CFE and VFSS at Boston Children's Hospital and compared presenting symptoms, symptom timing, and CFE and VFSS results. We investigated the relationship between symptom presence and aspiration using the Fisher exact test and stepwise logistic regression with adjustment for comorbidities. CFE and VFSS results were compared using the McNemar test. Intervals from CFE to VFSS were compared using the Student t test.

Results

A total of 412 subjects with mean (±SD) age 8.9 ± 6.9 months were evaluated. No symptom, including timing relative to meals, predicted aspiration on VFSS. This lack of association between symptoms and VFSS results persisted even in the adjusted multivariate model. The sensitivity of CFE for predicting aspiration by VFSS was 44%. Patients with a reassuring CFE waited 28.2 ± 8.5 days longer for confirmatory VFSS compared with those with a concerning CFE (P < .05).

Conclusions

Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.

Section snippets

Methods

We retrospectively reviewed the records of all children under 2 years of age who had both a CFE and VFSS for the evaluation of oropharyngeal dysphagia at Boston Children's Hospital in 2015. Records were reviewed for patient characteristics, comorbidities, and swallow study characteristics including radiation dose. VFSS results were considered abnormal if there was evidence of aspiration or laryngeal penetration seen for any texture. Laryngeal penetration was considered abnormal based on our

Results

We evaluated 412 total subjects with a mean age of 8.9 ± 6.9 months, all of whom had VFSS performed; 160 of these had both CFE and VFSS performed. Within the entire cohort, 38% (n = 156) of the VFSS showed aspiration, 33% (n = 137) showed penetration alone, and 27% (n = 107) did not show evidence of aspiration or penetration; 3% (n = 12) of subjects were unable to complete their VFSS. Subject characteristics, symptoms present at the time of referral, and subject comorbidities are shown in

Discussion

In the present study, we evaluated presenting symptoms for children under 2 years of age who had their first CFE and VFSS, and compared the agreement between these 2 modes of swallow evaluation, and determined the ability of each presenting symptom to predict VFSS and CFE results. We found that there was no single symptom that could reliably predict which patients would have evidence of aspiration on VFSS, and this translates to decreased sensitivity of the CFE compared with the VFSS.

Relatively

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    Supported by the Boston Children's Hospital Translational Research Program Senior Investigator Award (RR), NIH R01 DK097112 (RR) and NIH T32 DK007477 (DD). The authors declare no conflicts of interest.

    Portions of this study were presented at Digestive Disease Week, May 6-9, 2017, Chicago, Illinois and the NASPGHAN Annual Meeting, November 1-4, 2017, Las Vegas, Nevada.

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