Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children

Abstract

Objective To compare videofluoroscopy swallowing study (VFSS) with the fiberoptic endoscopic evaluation of swallowing (FEES) in children and to determine the accuracy of FEES in the diagnosis of specific swallowing disorders. Study Design Cross-sectional study. Setting Hospital da Criança Santo Antônio, affiliated with Santa Casa de Misericórdia Hospital Complex, Porto Alegre, RS, Brazil. Subjects and Methods FEES findings were compared to those of VFSS in 30 children. Kappa coefficients for interobserver agreement were calculated. Thereafter, these coefficients were evaluated in terms of agreement between FEES and VFSS. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of FEES were calculated for four swallowing parameters (posterior spillover, pharyngeal residues, laryngeal penetration, and laryngotracheal aspiration). Results Interobserver agreement rates greater than 70 percent were obtained for all FEES parameters analyzed, except for pharyngeal residues with puree consistency (agreement = 66.7%, κ = 0.296, P = 0.091). Laryngeal aspiration and penetration yielded the best level of agreement (100%, κ = 1) for the laryngeal aspiration of puree residues. Conclusion The diagnostic agreement between FEES (both observers) and VFSS was low. Regarding the analyzed parameters, laryngeal penetration and aspiration yielded the highest interobserver agreement in terms of FEES, and also showed the highest specificity and positive predictive value when compared to VFSS.