Comparison between clinical and videofluoroscopic evaluation of swallowing in children with suspected dysphagia

Silva-Munhoz, Lenice de Fatima da; Bühler, Karina Elena Bernardis; Limongi, Suelly Cecilia Olivan

doi:10.1590/2317-1782/20152014149

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Original Articles • CoDAS 27 (2) • Mar-Apr 2015 • https://doi.org/10.1590/2317-1782/20152014149 copy

Comparison between clinical and videofluoroscopic evaluation of swallowing in children with suspected dysphagia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose:

To verify the accuracy of clinical evaluation compared with videofluoroscopic swallowing studies in the detection of isolated laryngeal penetration and laryngeal aspiration in children with suspected dysphagia; to identify clinical signs and symptoms associated with isolated laryngeal penetration and laryngeal aspiration; and to determine the sensitivity and specificity of the clinical signs and symptoms identified.

Methods:

Retrospective analysis of data from clinical and videofluoroscopic evaluations carried out in 55 children from 1 month to 7 years and 11 months old. For clinical assessment, the Protocol for Clinical Assessment of Pediatric Dysphagia was used. The sensitivity, specificity, and positive and negative predictive values of clinical evaluation were analyzed. For statistical analysis, the Fisher's exact and χ² tests were used.

Results:

Clinical evaluation showed, in general, a sensitivity of 86% and a specificity of 32%. For isolated laryngeal penetration, clinical evaluation showed a sensitivity of 88%. For laryngeal aspiration, clinical evaluation showed a sensitivity of 86%. However, the specificity values were low for both alterations. There was no association between clinical evaluation and videofluoroscopic findings. Choking was the only clinical sign associated with isolated laryngeal penetration thin fluid and showed a sensitivity of 53% and a specificity of 77%.

Conclusions:

Clinical evaluation was sensible to detect isolated laryngeal penetration and laryngeal aspiration in children with suspected dysphagia. However, it showed a low specificity. Choking was the only clinical sign associated with isolated laryngeal penetration of thin fluid. More prospective studies are needed to confirm these findings in this population.

Infant; Child; Fluoroscopy; Deglutition; Disorders; Evaluation; Sensitivity and Specificity

Changes at CES	Changes at VFSS
	Present		Absent		Total		p-value
	n	%	n	%	n	%
Present	31	56	13	24	44	80	0.119
Absent	5	9	6	11	11	20
Total	36	65	19	35	55	100

Changes at CES	VFSS — isolated laryngeal penetration
	Present		Absent		Total		p-Value
	n	%	n	%	n	%
Present	15	27	29	53	44	80	0.525
Absent	2	4	9	16	11	20
Total	17	31	38	69	55	100

Changes at CES	VFSS — laryngeal aspiration
	Present		Absent		Total		p-Value
	n	%	n	%	n	%
Present	18	33	26	47	44	80	0.639
Absent	3	5	8	15	11	20
Total	21	38	34	62	55	100

Clinical evaluation			VFSS — isolated laryngeal penetration
			Thin liquid (n=45)					Thick liquid (n=21)
			Yes		No		p-Value	Yes		No		p-Value
			n	%	n	%		n	%	n	%
Clinical signs	General	Yes	13	87	24	80	0.699	1	33	12	67	0.531
		No	2	13	6	20		2	67	6	33
	CCA	Yes	5	33	15	50	0.289^a	0	0	10	56	0.214
		No	10	67	15	50		3	100	8	44
	CVQ	Yes	1	7	3	10	1.000	0	0	1	6	1.000
		No	14	93	27	90		3	100	17	94
	CRR	Yes	2	13	1	3	0.254	0	0	1	6	1.000
		No	13	87	29	97		3	100	17	94
	CHR	Yes	0	0	1	3	1.000	0	0	1	6	1.000
		No	15	100	29	97		3	100	17	94
	DSpO₂	Yes	3	20	6	20	1.000	1	33	6	33	1.000
		No	12	80	24	80		2	67	12	67
	Cough	Yes	3	20	11	37	0.321	0	0	5	28	0.549
		No	12	80	19	63		3	100	13	72
	Choking	Yes	8	53	7	23	0.044*^a	0	0	5	28	0.549
		No	7	47	23	77		3	100	13	72
	Cyanosis	Yes	1	7	2	7	1.000	0	0	1	6	1.000
		No	14	93	28	93		3	100	17	94
	RD	Yes	3	20	9	30	0.722	1	33	5	28	1.000
		No	12	80	21	70		2	67	13	72
Total			15	100	30	100		3	100	18	100

Clinical evaluation			VFSS — laryngeal aspiration
			Thin liquid (n=45)					Thick liquid (n=21)
			Yes		No		p-Value	Yes		No		p-Value
			n	%	n	%		n	%	n	%
Clinical signs	General	Yes	14	93	23	77	0.236	4	80	9	56	0.607
		No	1	7	7	23		1	20	7	44
	CCA	Yes	9	60	11	37	0.138^a	3	60	7	44	0.635
		No	6	40	19	63		2	40	9	56
	CVQ	Yes	2	13	2	7	0.591	0	0	1	6	1.000
		No	13	87	28	93		5	100	15	94
	CRR	Yes	1	7	2	7	1.000	0	0	1	6	1.000
		No	14	93	28	93		5	100	15	94
	CHR	Yes	1	7	0	0	0.333	0	0	1	6	1.000
		No	14	93	30	100		5	100	15	94
	DSpO₂	Yes	5	33	6	20	0.464	3	60	4	25	0.280
		No	10	67	24	80		2	40	12	75
	Cough	Yes	7	47	7	23	0.172	2	40	3	19	0.553
		No	8	53	23	77		3	60	13	81
	Choking	Yes	4	27	11	37	0.738	2	40	3	19	0.553
		No	11	73	19	63		3	60	13	81
	Cyanosis	Yes	2	13	1	3	0.254	0	0	1	6	1.000
		No	13	87	29	97		5	100	15	94
	RD	Yes	4	27	8	27	1.000	1	20	5	31	1.000
		No	11	73	22	73		4	80	11	69
Total			15	100	30	100		5	100	16	100

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E-mail: revista@codas.org.br

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[1] Correspondence address: Suelly Cecilia Olivan Limongi Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo Rua Cipotânea, 51, Cidade Universitária, São Paulo (SP), Brasil, CEP: 05360-160. E-mail: slimongi@usp.br