Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy

Abstract

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non‐ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients

“…In the present study, the total agreement was 62% and the kappa value was 0.228, although there was a statistical association between the two tests (p=0.011). The consistency was lower than expected, which is consistent with previous studies [9,10]. Possible explanations for these results are as follows.…”

“…It uses the scintigraphic method and traces material in the respiratory tract or not. It is used mostly in children with cerebral palsy to evaluate swallowing difficulties as it is safe and does not require radiation exposure or adequate cooperation [9,10]. Although the salivagram is a sensitive test as reported in previous studies, it is not established as a formal test for detecting salivary aspiration [10][11][12].…”

Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia

“…Bronchiectasis was also associated with parental report of GER, but not with the results of esophageal impedance studies or prior fundoplication (19). However, in this population with severe neurologic impairment, CRM may have been predominantly due to chronic aspiration of saliva (20), and the findings may be of less relevance to populations with aspiration predominantly due to other causes. In patients with bronchiolitis obliterans syndrome post-lung transplant, GERD appears to play an important role in worsening lung function, and lung function improves with fundoplication (21).…”

Salivagram After Gland Injection of Botulinum Neurotoxin A in Patients With Cerebral Infarction and Cerebral Palsy

“…This test may be useful for detection of aspiration of saliva and for patients with limitations of oral feeding or poor cooperation. For these reasons, a radionuclide salivagram has been used in infants or children with neurologic diseases, for example, cerebral palsy, who have recurrent pulmonary infection [4][5][6]. A radionuclide salivagram can be performed under more physiological conditions without the challenge of an oral bolus for swallowing and is less invasive than a videofluoroscopic swallow study or a fiberoptic-endoscopic evaluation of swallowing [4].…”

“…After establishment of pulmonary aspiration of saliva, injection of the salivary gland with BoNT-A was conducted for control of saliva aspiration. BoNT-A (Botox; Allergan Inc, Irvine, CA) was diluted with 0.9% saline solution to 100 U per 2 mL and was then injected (total of 100 U, 25 U per gland), through a 26-gauge needle, into the bilateral parotid and submandibular glands under ultrasound guidance (5)(6)(7)(8)(9)(10)(11)(12)(13) MHz linear transducer; Antares, Enlargen, Germany) [2,10]. A follow-up salivagram, performed 16 days after injection of BoNT-A, showed no extraesophageal uptake of radiotracer for pulmonary aspiration.…”