Exploration of the relationships among medical health history variables and aspiration
Received 10 November 2009; received in revised form 12 January 2010; accepted 15 January 2010.
Abstract
Objectives
(1) Determine the relationships among a family's specific answers to health history questions and their child's risk for aspiration as determined by a swallow study. (2) Identify key factors which may predict a child's risk for aspiration.
Methods
Answers to questions and results of Functional Endoscopic Evaluation of Swallow (FEES) and/or Video Swallow Study (VSS) for a sample of 198 children were collected. Subjects were categorized into groups: “aspiration”, “penetration” or “no aspiration or penetration”. Logistic regression modeling was used to determine the contribution of certain characteristics to the odds of aspiration. A model for predicting aspiration or penetration based on those characteristics was assessed. The sensitivity and specificity of the model in predicting aspiration and penetration was determined.
Results
One hundred ninety eight subjects had a FEES or VSS. Of these, 18% (n=36) aspirated and 21% (n=42) were found to have penetration. Many of the factors identified in the health history were found to be significantly associated with aspiration or penetration. The variables “demonstrated aspiration” (this included parent or caregiver seeing food in the tracheotomy tube or aspiration noted on a previous FEES or VSS) (p=0.02), “hypotonia” (p=0.02) and “tracheotomy” (p=0.001) were most predictive of aspiration. History of tracheotomy was found to have an inverse relationship with aspiration. “gastroesophageal reflux” (GER) (p=0.0007) was most significantly associated with penetration, followed by “prematurity” (p=0.03) and “developmental delays” (p=0.04). Based on the prediction model, the probabilities for a child with a history of combinations of the above variables to have aspiration or penetration were calculated.
Conclusions
Significant relationships exist between aspiration or penetration and the family's answers about their child's medical history. Practitioners should consider a swallow assessment whenever a child has a history which includes variables with a strong association with aspiration or penetration.
aCenter for Professional Excellence, Cincinnati Children's Hospital Medical Center, United States
bDivision of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, United States
cDivision of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, United States
Corresponding author at: Center for Professional Excellence - Research and Evidence Based Practice, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 11016, Cincinnati, OH 45229-3039, United States. Tel.: +1 513 803 0504; fax: +1 513 636 9765.
ABSTRACT