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Predicting penetration–aspiration through quantitative swallow measures of children: a videofluoroscopic study

European Archives of Oto-Rhino-Laryngology volume 278, pages 1907–1916 (2021)Cite this article

Abstract

Purpose

Quantitative measures have improved the reliability and accuracy in interpretation and reporting of videofluoroscopy (VFSS). Associations between quantitative VFSS measures and swallow safety in children are not widely reported. The ability to predict aspiration in children, even if not observed during brief VFSS, will improve diagnostic reporting and potentially reduce the need for extended radiation time. The aims of this study were to determine associations between quantitative fluoroscopic swallow measures and penetration–aspiration and to predict likelihood of penetration–aspiration.

Methods

We selected videofluoroscopic data of 553 children from a pediatric hospital database for this single-center retrospective observational study. A standard protocol of VFSS administration was used and data were recorded at 30 frames-per-second. A set of quantitative and descriptive swallow measures was obtained using a specialized software with satisfactory inter-rater and intra-rater reliability. Binomial logistic regression with backward likelihood ratio was conducted, while controlling for age, gender, and etiology.

Results

We found bolus clearance ratio (BCR), pharyngeal constriction ratio (PCR), duration to hyoid maximal elevation (Hdur), and total pharyngeal transit time (TPT) to be predictive of penetration–aspiration in children. PCR was the most predictive of penetration–aspiration in children (61.5%). Risk of aspiration was more than 100 times, when BCR =  ≥ 0.1, TPT =  ≥ 2 s, Hdur =  > 1 s or PCR =  ≥ 0.2 (p < 0.05 for all measures).

Conclusion

The results confirm the potential of objective quantitative swallow measures in predicting the risk of aspiration in children with dysphagia. These parameters provide predictive measures of aspiration risk that are clinically useful in identifying children of concern, even if no aspiration is observed during VFSS.

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Acknowledgements

We are thankful to the speech-language therapists of the Starship Children’s Hospital, Auckland, New Zealand, for their support in maintaining VFSS protocol and collecting VFSS data; Daniel Barnett, The University of Auckland, New Zealand, for statistical support and Hasith Kandaudahewa, University of Colombo, Sri Lanka, for support in formatting.

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Affiliations

  1. Speech Science, School of Psychology, Faculty of Science, The University of Auckland, Building 507, Level 2 (B.065), 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand

    Isuru Dharmarathna & Anna Miles

  2. Department of Surgery, The University of Auckland, Auckland, New Zealand

    Jacqui Allen

  3. Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka

    Isuru Dharmarathna

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  1. Isuru Dharmarathna
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  2. Anna Miles
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Correspondence to Isuru Dharmarathna.

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Dharmarathna, I., Miles, A. & Allen, J. Predicting penetration–aspiration through quantitative swallow measures of children: a videofluoroscopic study. Eur Arch Otorhinolaryngol 278, 1907–1916 (2021). https://doi.org/10.1007/s00405-021-06629-4

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  • DOI: https://doi.org/10.1007/s00405-021-06629-4

Keywords

  • Dysphagia
  • Deglutition disorders
  • Fluoroscopy
  • Swallowing disorders
  • Aspiration
  • Children