Quantitative objective videofluoroscopic swallowing measures in children

Abstract

Background: Reproducible quantitative swallowing data in children is scarce and could aid clinical decision making. The present study investigated the feasibility of utilising objective measures of timing and displacement in children undergoing a videofluoroscopic swallowing study (VFSS). Methods: One hundred and thirty-three children (mean age 36 mth, range 9 d–21 y, SD 4 y) consecutively referred for a VFSS over 12 months were recruited. Children presented with varying causes of dysphagia: 38% neurological, 26% structural 20% unknown, 10% respiratory, 4% cardiac and 3% other. All children received a standardised protocol including a mid-feed 20-second loop recorded at 25 frames per second. All videos were analysed using objective digital measures of timing and displacement previously described by Leonard and Kendall (1997). Results: Mean radiation time was 1.58 minutes (range 0.15–3.47, SD .66) and mean radiation dose was 30.16 cGycm2 (range 6.5–85 SD, 15.17). Radiation dose (p = .21) and radiation time (p = .72) were not significantly different using the increased frame rate compared with an age-matched cohort (N:133) prior to protocol change. Thirty-five per cent of children aspirated. Younger children were significantly more likely to silently aspirate than older children (p < .01). Mean pharyngeal transit time was .99 s (range 0.27–10.6, SD 1.8). Mean pharyngoesophageal segment opening was 0.52 cm (range 0.17–.98, SD .20). Mean pharyngeal constriction ratio was 0.02 (range 0–0.53, SD.07). Inter-rater reliability was substantial (ICC .88). PES maximum opening (p < .001) and PES opening duration (p < .001) significantly increased with age, whereas pharyngeal transit time significantly decreased with age (p < .05). Higher penetration-aspiration scale scores were associated with longer bolus transit scores (p < .05). Conclusion: Few studies have examined objective videofluoroscopic measures of swallowing in children. This novel study demonstrates the feasibility of recording reproducible and reliable objective data. The relationship between displacement measures and increasing age is consistent with findings in adults and suggests internal validity. Radiation exposure time is within normal range. This approach ensures studies have been optimised to obtain as much information as possible. Objective measures may provide clinicians with greater predictive value of risk than observation of aspiration alone. In time, objective measures may guide clinicians to develop informed management plans.