Comparison of Videofluoroscopic Swallowing Study and Radionuclide Salivagram for Aspiration Pneumonia in Children With Swallowing Difficulty

Abstract

ObjectiveTo determine whether the use of both videofluoroscopic swallowing study (VFSS) and radionuclide salivagram was beneficial for detecting aspiration-induced pneumonia in children with swallowing difficulty.MethodsFrom 2001 to 2016, children who underwent both VFSS and salivagram consecutively for suspected aspiration or dysphagia were included in the study. Demographic data, findings of VFSS and salivagram, and medical records were reviewed.ResultsAspiration pneumonia (AP) was present in 34 out of 110 children; 48 showed positive aspiration findings in VFSS and 33 showed positive aspiration findings in salivagram. Among the 62 children who were negative of aspiration in VFSS, 12 (19.4%) showed positive aspiration findings in salivagram. Four out of 12 children were diagnosed with AP. The aspiration findings in both VFSS and salivagram were significantly related to AP. However, the aspiration findings in the two tests were weakly consistent. Even if one test showed negative aspiration, it was helpful to additionally detect AP using another test, which showed positive aspiration finding. If aspiration findings were positive in only one of the two tests, the probability of AP was 38.5%, whereas if they were positive in both tests, the probability increased to 66.7%. If the aspiration findings were negative in both tests, AP did not occur with a probability of 90%.ConclusionSalivagram is a valuable tool for monitoring of aspiration in children with swallowing difficulties. It could be helpful in assessment of children at a high risk of AP, even if the VFSS showed negative aspiration findings. Thus, testing for AP using both VFSS and salivagram is desirable.

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion

“…[4] In those studies, the authors estimated that the significant false-negative results of VFSS in predicting aspiration pneumonia may be due to episodic aspiration that may not be accurately reflected during examination, or salivary aspiration, which cannot be detected in VFSS. [5,6]…”

“…In order to overcome these limitations of VFSS in predicting aspiration pneumonia, the radionuclide salivagram has been investigated as a tool to complement VFSS in previous studies. [3,5–7] In addition to aspiration in VFSS, multiple previous cerebral infarctions, brainstem stroke, oral hygiene, previous cardiopulmonary disease (e.g., chronic obstructive pulmonary disease and congestive heart failure), salivary aspiration, masticatory muscle paralysis, abolition of gag reflex, and impaired cough reflex have been reported as another risk factor of the aspiration pneumonia in the previous studies. [8–11] However, although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke.…”

Algoritmo para el manejo de la aspiración pulmonar crónica en pediatría

“…6 Los beneficios y las limitaciones de cada uno se resumen en la Tabla 2. 1,2,[5][6][7]10,14 Tanto los trastornos de la deglución faríngea (penetración y aspiración) como los trastornos esofágicos y el reflujo pueden dar lugar a neumonía recurrente. Por lo tanto, todas las fases de deglución deben ser consideradas durante la evaluación de la deglución.…”

“…Los beneficios y las limitaciones de estos estudios y otros exámenes complementarios se resumen en la Tabla 3. 5,10,17 Hay niños con múltiples evaluaciones negativas para disfunción de la deglución o RGE, pero con historia clínica sugestiva de aspiración y evidencia radiológica de enfermedad pulmonar; en ellos, el diagnóstico de aspiración se hace solamente cuando se ensaya la alimentación exclusiva por sonda nasogástrica y mejoran los síntomas respiratorios. 5 En los niños que continúan con síntomas de aspiración a pesar del cese de la alimentación oral y del tratamiento del No detecta RGE no ácido.…”

“…4 Si bien la aspiración es más frecuente en los niños con trastornos neurológicos (del 35 % al 80 %), una proporción significativa de niños sin anomalías neurológicas presentan aspiración, por lo general, debido a anomalías anatómicas o inflamatorias. 1,2,8,10,11 No hay una prueba de referencia (gold standard) para el diagnóstico de la APC, por lo que constituye un desafío. El enfoque de un equipo multidisciplinario permite la evaluación global coordinada y la planificación de la terapia.…”