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

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.Pediatrics. 2001 Sep;108(3):671-6. (PMID: 11533334); Clin Rehabil. 2002 Sep;16(6):640-5. (PMID: 12392339); Eur Respir J. 2006 Oct;28(4):847-61. (PMID: 17012631); Dysphagia. 1994 Winter;9(1):63-8. (PMID: 8131427); Pediatrics. 2001 Dec;108(6):E106. (PMID: 11731633); Nutr Clin Pract. 2002 Dec;17(6):373-8. (PMID: 16215014); Eur Respir J. 2009 Mar;33(3):604-11. (PMID: 19010985); Curr Opin Otolaryngol Head Neck Surg. 2010 Dec;18(6):554-63. (PMID: 20885326); Dev Med Child Neurol. 2005 Mar;47(3):149-57. (PMID: 15739718); Dysphagia. 2004 Fall;19(4):231-40. (PMID: 15667057); Pediatr Pulmonol. 2007 Nov;42(11):1024-31. (PMID: 17893917); Arch Phys Med Rehabil. 1988 Aug;69(8):637-40. (PMID: 3408337); Pediatr Radiol. 2006 Sep;36(9):911-9. (PMID: 16552584); Chest. 2011 Sep;140(3):589-597. (PMID: 21436244); Arch Phys Med Rehabil. 1983 Jun;64(6):281-4. (PMID: 6860100); Dysphagia. 2002 Fall;17(4):308-15. (PMID: 12355146); Dev Med Child Neurol. 2000 Apr;42(4):235-9. (PMID: 10795561); Dysphagia. 2007 Jul;22(3):225-34. (PMID: 17457548); Trials. 2013 Nov 07;14:377. (PMID: 24199872); CJEM. 2006 Jan;8(1):19-20. (PMID: 17175625); Dysphagia. 1996 Spring;11(2):93-8. (PMID: 8721066); Acta Paediatr. 1996 Jun;85(6):697-701. (PMID: 8816207); Dysphagia. 2011 Dec;26(4):374-84. (PMID: 21225287); Dysphagia. 2004 Fall;19(4):211-8. (PMID: 15667055); Ann Otol Rhinol Laryngol. 1991 Aug;100(8):678-81. (PMID: 1872520); Arch Pediatr Adolesc Med. 2000 Feb;154(2):190-4. (PMID: 10665608); Dysphagia. 1998 Fall;13(4):223-7. (PMID: 9716754); Pediatr Radiol. 2007 Mar;37(3):283-90. (PMID: 17216172); Dysphagia. 1995 Winter;10(1):27-31. (PMID: 7859529); J Pediatr. 1996 Dec;129(6):877-82. (PMID: 8969730); Clin Rehabil. 2016 Feb;30(2):199-207. (PMID: 25792689); Dysphagia. 2016 Feb;31(1):1-23. (PMID: 26607159); Dysphagia. 2003 Winter;18(1):53-7. (PMID: 12497197); Folia Phoniatr Logop. 1999 Jul-Oct;51(4-5):158-71. (PMID: 10450023); Dev Med Child Neurol. 2003 Jul;45(7):442-6. (PMID: 12828397); Dysphagia. 2001 Spring;16(2):110-8. (PMID: 11305220); Dysphagia. 2002 Winter;17(1):40-9. (PMID: 11824392); Curr Gastroenterol Rep. 2005 Jun;7(3):240-3. (PMID: 15913485); COPD. 2005 Mar;2(1):57-62. (PMID: 17136963); Dev Neurorehabil. 2010;13(3):192-203. (PMID: 20450469); Laryngoscope. 2000 Jul;110(7):1132-6. (PMID: 10892683); Dev Med Child Neurol. 2012 Sep;54(9):784-95. (PMID: 22582745). Linking ISSN: 0179051X. Subset: MEDLINE; Date of Electronic Publication: 2016 Jul 11. ; Original Imprints: Publication: New York : Springer-Verlag, [c1986- <br />