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The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial

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Abstract

In this study, we aimed to determine if the use of cervical auscultation (CA) as an adjunct to the clinical feeding evaluation (CFE + CA) improves the reliability of predicting oropharyngeal aspiration (abbreviated to aspiration) in children. The design of the study is based on open label, randomized controlled trial with concealed allocation. Results from children (<18 years) randomized to either CFE or CFE + CA were compared to videofluoroscopic swallow study (VFSS), the reference standard data. Aspiration was defined using the Penetration-Aspiration Scale. All assessments were undertaken at a single tertiary pediatric hospital. 155 children referred for a feeding/swallowing assessment were randomized into the CFE n = 83 [38 males; mean age = 34.9 months (SD 34.4)] or CFE + CA n = 72 [43 males; mean age = 39.6 months (SD 39.3)] group. kappa statistic, sensitivity, and specificity values, area under receiver operating curve (aROC). No significant differences between groups were found, although CFE + CA (kappa = 0.41, 95 % CI 0.2–0.62) had higher agreement for aspiration detection by VFSS, compared to the clinical feeding exam alone (kappa = 0.31, 95 % CI 0.10–0.52). Sensitivity was 85 % (95 % CI 62.1–96.8) for CFE + CA and 63.6 % (95 % CI 45.1–79.6) for CFE. aROC was not significantly greater for CFE + CA (0.75, 95 % CI 0.65–0.86) than CFE (0.66, 95 % CI 0.55–0.76) across all age groups. Although using CA as an adjunct to the clinical feeding evaluation improves the sensitivity of predicting aspiration in children, it is not sensitive enough as a diagnostic tool in isolation. Given the serious implications of missing the diagnosis of aspiration, instrumental assessments (e.g., VFSS), remain the preferred standard.

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References

  1. Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol. 2007;42:1024–31.

    Article  PubMed  Google Scholar 

  2. Weir K, McMahon S, Taylor S, Chang AB. Oropharyngeal aspiration and silent aspiration in children. Chest. 2011;140:589–97.

    Article  PubMed  Google Scholar 

  3. Burklow KA, McGrath AM, Valerius KS. Relationship between feeding difficulties, medical complexity, and gestational age. Nutr Clin Pract. 2002;17:373–8.

    Article  PubMed  Google Scholar 

  4. Schwarz SM, Corredor J, Fisher-Medina J. Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics. 2001;108:671–6.

    Article  CAS  PubMed  Google Scholar 

  5. Hawdon JM, Beauregard N, Slattery J, Kennedy G. Identification of neonates at risk of developing feeding problems in infancy. Dev Med Child Neurol. 2000;42:235–9.

    Article  CAS  PubMed  Google Scholar 

  6. Newman LA, Keckley C, Petersen MC, Hamner A. Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatrics. 2001;108:e106.

    Article  CAS  PubMed  Google Scholar 

  7. Reilly S, Skuse D, Poblete X. Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J Paediatr. 1996;129:877–82.

    Article  CAS  Google Scholar 

  8. Dahl M, Thommessen M, Rasmussen M. Feeding and nutritional characteristics in children with moderate or severe cerebral palsy. Acta Paediatr. 1996;85:697–701.

    Article  CAS  PubMed  Google Scholar 

  9. Boesch RP, Daines C, Willging JP. Advances in the diagnosis and management of chronic pulmonary aspiration in children. Eur Respir J. 2006;28:847–61.

    Article  CAS  PubMed  Google Scholar 

  10. Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol. 2011;47:1–17.

    Google Scholar 

  11. Owayed AF, Campbell DM, Wang EEL. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med. 2000;154:190–4.

    Article  CAS  PubMed  Google Scholar 

  12. Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.

    Article  CAS  PubMed  Google Scholar 

  13. Rao N, Brady SL, Chaudhuri G. Gold standard? Analysis of the videofluroscopic and fiberoptic endoscopic swallow examinations. J Appl Res. 2003;3:80–96.

    Google Scholar 

  14. McCullogh GH, Wertz RT, Rosenbek JC. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16:110–8.

    Article  Google Scholar 

  15. Scott A, Perry A, Bench J. A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia. 1998;13:223–7.

    Article  CAS  PubMed  Google Scholar 

  16. Stoeckli SJ, Huisman TA, Seifert B, Martin-Harris B. Interrater reliability of videofluroscopic swallow evaluation. Dysphagia. 2003;18:53–7.

    Article  PubMed  Google Scholar 

  17. Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17:308–15.

    Article  PubMed  Google Scholar 

  18. Leder SB, Karas DE. Fiberoptic endoscopic evaluation of swallowing in the pediatric population. Laryngoscope. 2000;110:1132–6.

    Article  CAS  PubMed  Google Scholar 

  19. Weir KA, McMahon SM, Long G, Bunch JA, Pandeya N, Coakley KS, Chang AB. Radiation doses to children during modified barium swallow studies. Pediatr Radiol. 2007;37:283–90.

    Article  PubMed  Google Scholar 

  20. Willging JP, Thompson DM. Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing. Curr Gastroenterol Rep. 2005;7:240–3.

    Article  PubMed  Google Scholar 

  21. Heckathorn D, Speyer R, Taylor J, Cordier R. Systematic review: non-instrumental swallowing and feeding assessments in pediatrics. Dysphagia. 2016;31:1–23.

    Article  PubMed  Google Scholar 

  22. DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluorospic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol. 2005;47:149–57.

    Article  PubMed  Google Scholar 

  23. Gosa M, Suiter DM, Powers L, Palmer F, Temple C, Petersen M. Reliability of the penetration-aspiration scale for use with infants and young children. Vancouver: Dysphagia Research Society; 2007. p. 369–407.

    Google Scholar 

  24. Splaingard ML, Hutchins B, Sulton LD, Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil. 1988;69:637–40.

    CAS  PubMed  Google Scholar 

  25. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed Incorporated; 1998.

    Google Scholar 

  26. Linden P, Siebens A. Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehabil. 1983;64:281–3.

    CAS  PubMed  Google Scholar 

  27. Reynolds EW, Vice FL, Gewolb IH. Cervical accelerometry in preterm infants with and without bronchopulmonary dysplasia. Dev Med Child Neurol. 2003;45:442–6.

    Article  PubMed  Google Scholar 

  28. Rommel N. Diagnosis of oropharyngeal disorders in young children. Leuven: Katholieke Universiteit Leuven; 2002.

    Google Scholar 

  29. Borr C, Hielscher-Fastabend M, Lucking A. Reliability and validity of cervical auscultation. Dysphagia. 2007;22:225–34.

    Article  PubMed  Google Scholar 

  30. Leslie P, Drinnan MJ, Finn P, Ford GA, Wilson JA. Reliability and validity of cervical auscultation: a controlled comparison using videofluoroscopy. Dysphagia. 2004;19:231–40.

    PubMed  Google Scholar 

  31. Shaw JL, Sharpe S, Dyson SE, Pownall S, Walters S, Saul C, Enderby P, Healy K, O’Sullivan H. Bronchial auscultation: an effective adjunct to speech and language therapy bedside assessment when detecting dysphagia and aspiration? Dysphagia. 2004;19:211–8.

    Article  PubMed  Google Scholar 

  32. Stroud AE, Lawrie BW, Wiles CM. Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Clin Rehabil. 2002;16:640–5.

    CAS  PubMed  Google Scholar 

  33. Zenner PM, Losinski DS, Mills RH. Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia. 1995;10:27–31.

    Article  CAS  PubMed  Google Scholar 

  34. Eicher PS, Manno CJ, Fox CA, Kerwin ME. Impact of cervical auscultation on accuracy of clinical evaluation in predicting penetration/aspiration in a pediatric population. Dysphagia. 1995;10:132–4.

    Article  Google Scholar 

  35. Lagarde M, Kamalski D, van den Engel-Hoek L. The reliability and validity of cervical auscultation in the diagnosis of dysphagia: a systematic review. Clin Rehabil. 2015;19:0269215515576779.

    Google Scholar 

  36. Frakking T, Chang AB, O’Grady K, Weir K. Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial. Trials. 2013;14:1.

    Article  Google Scholar 

  37. Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical assessment of swallowing and prediction of dysphagia. Am J Speech Lang Pathol. 1997;6:17–24.

    Article  Google Scholar 

  38. Australia SP. Speech Pathology Australia’s dysphagia clinical guidelines. Melbourne: Speech Pathology Australia; 2012.

    Google Scholar 

  39. Weir K, McMahon S, Barry L, Masters IB, Chang AB. Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children. Eur Respir J. 2009;33:604–11.

    Article  CAS  PubMed  Google Scholar 

  40. Cichero JAY, Murdoch BE. Detection of swallowing sounds: methodology revisited. Dysphagia. 2002;17:40–9.

    Article  PubMed  Google Scholar 

  41. Miller RM. Evaluation of swallowing disorders. In: Groher ME, editor. Dysphagia diagnosis & management. Stoneham: Butter-worth Publishers; 1984.

    Google Scholar 

  42. O’Donoghue S, Bagnall A. Videofluroscopic evaluation in the assessment of swallowing disorders in paediatric and adult populations. Folia Phoniatr Logop. 1999;51:158–71.

    Article  PubMed  Google Scholar 

  43. Hiorns MP, Ryan MM. Current practice in paediatric videofluoroscopy. Pediatr Radiol. 2006;36:911–9.

    Article  PubMed  Google Scholar 

  44. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  45. Hamlet S, Penney DG, Formolo J. Stethoscope acoustics and cervical auscultation of swallowing. Dysphagia. 1994;9:63–8.

    Article  CAS  PubMed  Google Scholar 

  46. Sloan JA. Assessing the minimally clinical significant difference: scientific considerations, challenges and solutions. J Chronic Obstr Pulm Dis. 2005;2:57–62.

    Article  Google Scholar 

  47. Fan J, Upadhye S, Worster A. Understanding receiver operating chracteristic (ROC) curves. Can J Emerg Med. 2006;8:19–20.

    Google Scholar 

  48. Reimers-Neils L, Logemann JA, Larson C. Viscosity effects on EMG activity in normal swallow. Dysphagia. 1994;9:101–6.

    Article  CAS  PubMed  Google Scholar 

  49. Youmans SR, Stierwalt JA. Normal swallowing acoustics across age, gender, bolus viscosity, and bolus volume. Dysphagia. 2011;26:374–84.

    Article  PubMed  Google Scholar 

  50. Richter GT. Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg. 2010;18:554–63.

    Article  PubMed  Google Scholar 

  51. Benfer KA, Weir K, Boyd R. Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review. Dev Med Child Neurol. 2012;54:784–95.

    Article  PubMed  Google Scholar 

  52. Morgan AT. Dysphagia in childhood traumatic brain injury: a reflection on the evidence and its implications for practice. Dev Neurorehabil. 2010;13(3):192–203.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Children’s Health Foundation, Queensland; Queensland Children’s Medical Research Institute; and the Allied Health Near Miss Grant (No. 50111). TTF is supported by PhD scholarships provided by the Children’s Health Foundation, Queensland Children’s Medical Research Institute (No. 50032), the NHMRC (No. 1055527), and the Speech Pathology, Australia. ABC is supported by the NHMRC Practitioner Fellowship (No. 1058213). KFO is supported by the NHMRC Career Development Fellowship (No. 1045157), and a Queensland Government Smart Futures Fellowship.

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Authors and Affiliations

  1. Centre for Children’s Health Research, The University of Queensland, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia

    Thuy T. Frakking & Kelly A. Weir

  2. Speech Pathology Department, Lady Cilento Children’s Hospital, Level 6a, 501 Stanley St, South Brisbane, QLD, 4101, Australia

    Thuy T. Frakking, Katie Walker-Smith & Kelly A. Weir

  3. Queensland Children’s Respiratory Centre, Lady Cilento Children’s Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia

    Anne B. Chang

  4. Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia

    Anne B. Chang

  5. Centre for Children’s Health Research, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia

    Anne B. Chang & Kerry-Ann F. O’Grady

  6. School of Public Health, The University of Queensland, Herston Rd, Herston, QLD, 4029, Australia

    Michael David

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  1. Thuy T. Frakking
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Correspondence to Thuy T. Frakking.

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Australia and New Zealand Clinical Trials Register ACTRN12613000589785.

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Frakking, T.T., Chang, A.B., O’Grady, KA.F. et al. The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial. Dysphagia 31, 738–748 (2016). https://doi.org/10.1007/s00455-016-9727-5

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