Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement

Abstract

Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions. After 3 iterations of survey, consensus was obtained by either a supermajority of 75% or stability in median ranking on 33 of 36 items. This included a standard definition of an aerodigestive patient, level of participation of specific pediatric disciplines in a program, essential components of the care cycle and functions of the program, feeding and swallowing assessment and therapy, procedural scope and volume, research priorities and outcome measures, certification, coding, and funding. We propose the first consensus definition of the aerodigestive care model with specific recommendations regarding associated personnel, infrastructure, research, and outcome measures. We hope that this may provide an initial framework to further standardize care, develop clinical guidelines, and improve outcomes for aerodigestive patients.

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

“…Aerodigestive programs have been proliferating since their advent in the late 1990s with a goal of improving quality and efficiency of aerodigestive care . The extensive testing proposed by aerodigestive programs is aimed at assessing the possible correlation of esophageal and GI diagnoses on airway symptoms . This study evaluated the yield, regardless of needing eventual therapy, of radiographic and procedural GI testing in children referred to an aerodigestive clinic.…”

“…Multidisciplinary pediatric aerodigestive programs are increasing to help provide diagnosis and management of medically complex children with combined gastrointestinal (GI) and airway disorders. Most programs include a pulmonologist, gastroenterologist, otolaryngologist, speech language pathologist, and a dietician . Some programs may also include other service lines such as occupational therapy, general pediatrics, genetics, surgery, anesthesiology, and/or radiology .…”

“…Most programs include a pulmonologist, gastroenterologist, otolaryngologist, speech language pathologist, and a dietician . Some programs may also include other service lines such as occupational therapy, general pediatrics, genetics, surgery, anesthesiology, and/or radiology . Historically, these specialties have functioned separately “in siloes” versus integrated within a single clinic due to their expense necessitating extensive investment by the hospital …”

“…1 Some programs may also include other service lines such as occupational therapy, general pediatrics, genetics, surgery, anesthesiology, and/or radiology. 1 Historically, these specialties have functioned separately "in siloes" versus integrated within a single clinic due to their expense necessitating extensive investment by the hospital. 2,3 There has been limited research regarding the most effective algorithm of diagnostic testing in the aerodigestive clinic and its subsequent impact on clinical outcomes.…”

Interventional radiology in the airway in children

“…Planning for anesthesia may be complicated by small patient size or concomitant pathology, most notably congenital cardiac disease. We believe that the care of children with complex airway problems is best carried out by an experienced multidisciplinary team (MDT) in a specialist pediatric center . The anesthetist has an important role as a part of decision‐making in overall patient management, as well as providing anesthesia for airway procedures.…”