The use of cervical auscultation to predict oropharyngeal aspiration in children: A randomized controlled trial

Frakking, Thuy T., Chang, Anne B., O'Grady, Kerry-Ann, David, Michael, Walker-Smith, Katie, & Weir, Kelly A. (2016) The use of cervical auscultation to predict oropharyngeal aspiration in children: A randomized controlled trial. Dysphagia. (In Press)

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Abstract

Objectives

  • 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.

Design

  • Open label randomised controlled trial with concealed allocation. Results from children (<18 years) randomised 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.

Setting

  • All assessments were undertaken at a single tertiary paediatric hospital.

Participants

  • 155 children referred for a feeding/swallowing assessment were randomised 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.

Outcome Measures

  • kappa statistic, sensitivity and specificity values, area under receiver operating curve (aROC).

Results

  • No significant difference between groups was 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.

Conclusions

  • Although using CA as an adjunct to the clinical feeding evaluation improves the sensitivity of diagnosing aspiration in children, it is not sensitive enough as a diagnostic tool. Given the serious implications of missing the diagnosis of aspiration, instrumental assessments (e.g. VFSS), remain the preferred standard.

Clinical trial registration: Australia and New Zealand Clinical Trials Register ACTRN12613000589785.

Impact and interest:

1 citations in Scopus
2 citations in Web of Science®
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ID Code: 96410
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Oropharyngeal Aspiration, Children, Cervical Ausculation, Diagnosis
DOI: 10.1007/s00455-016-9727-5
ISSN: 1432-0460
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Deposited On: 30 Jun 2016 00:47
Last Modified: 30 Sep 2016 02:55

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