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Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

Weir, K., Mcmahon, S., Barry, L., Masters, Ian B. and Chang, Anne B. (2009). Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children. European Respiratory Journal,33(3):604-611.

Document type: Journal Article

IRMA ID 10491xPUB71
Title Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children
Author Weir, K.
Mcmahon, S.
Barry, L.
Masters, Ian B.
Chang, Anne B.
Journal Name European Respiratory Journal
Publication Date 2009
Volume Number 33
Issue Number 3
ISSN 1399-3003   (check CDU catalogue open catalogue search in new window)
Start Page 604
End Page 611
Total Pages 8
Place of Publication Switzerland
Publisher European Respiratory Society
HERDC Category C1 - Journal Article (DEST)
Abstract The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA. In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction. In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87–27.62), wet breathing (OR 3.35, 95% CI 1.09–10.28) and cough (OR 3.30, 95% CI 1.17–9.27) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67; specificity 0.92); wet breathing (sensitivity 0.33; specificity 0.83); and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22–10.55). Differences were found for age. Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.
Keywords aspiration
clinical signs
dysphagia
modified barium swallow
oropharyngeal aspiration
videofluoroscopy
DOI http://dx.doi.org/10.1183/09031936.00090308   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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