Impact of video-fluoroscopic swallow studies on paediatric feeding management and clinical status

Abstract

Background: In children with suspected aspiration, clinical swallow assessment (CSA) may be supplemented with video-fluoroscopic swallow studies (VFSS) to inform feeding management. Aim: To assess the diagnostic accuracy of CSA, compared to VFSS and evaluate the impact of VFSS on feeding management and clinical status. Method: Retrospective case review of children who underwent CSA, followed by VFSS in a tertiary centre. Results: 113 children underwent VFSS at age 2.2 (0.1-17.9) years, median (range). Diagnoses were syndromic entities (38, 34%), CNS dysfunction (28, 25%), anatomic abnormalities (18, 16%), CNS malformation (7, 6%), neuromuscular disease (6, 5%) and other (16, 14%). 62% had laryngeal penetration or aspiration per CSA, compared to 38% per VFSS, p VFSS based feeding route recommendations differed significantly from those based on prior CSA, p=0.04. Following VFSS, the rate of orally fed children rose from 66% to 78%, p=0.006. However, exclusive gastrostomy feeding also increased, from 7% to 12%, p=0.005. In the year after VFSS, compared to the year prior, total hospital admissions fell from 364 to 252, p Conclusion: CSA overestimated the presence of overall swallowing abnormalities, but underestimated silent aspirations. VFSS led to change in feeding route and advice, which was associated with clinical improvement.