Using the Radionuclide Salivagram to Detect Pulmonary Aspiration and Esophageal Dysmotility

Levin, Kenneth; Colón, A. R.; DiPalma, Jack A.; Fitzpatrick, Sean

doi:10.1097/00003072-199302000-00003

Cited by 35 publications

(15 citation statements)

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“…This compares with 25% of 20 children with respiratory disease studied by Boonyaprapa et al (1980). None of the 13 patients studied by Levin et al (1993) had a positive scan, whereas 5% of the children with gastro-oesophageal reflux, 20% of the children with apparent life-threatening events, and 23% of the children with recurrent respiratory events studied by McVeagh et al (1987) had a positive scan.…”

Section: Discussionmentioning

confidence: 94%

“…The studies that report more than three participants describe an incidence of aspiration between 26 and 70% (Huxley et al 1978, Heyman and Respondek 1989, Levin et al 1993, BarSever et al 1995. The report of 70% positive studies was by Huxley et al (1978); it used a different method, with the instillation of radiopharmaceutical during sleep, and in volumes in excess of those that would be produced from normal saliva production.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the salivagram is a more recently described investigation (Huxley et al 1978, Heyman 1989, Silver et al 1991, Silver and Van Nostrand 1992, Levin et al 1993, Bar-Sever et al 1995. These three types of investigations are thought to identify those children with CP at risk of ongoing lung disease, although the evidence that any are good predictors of ongoing respiratory ill health is scant.…”

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confidence: 99%

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

Baikie

South

Reddihough

et al. 2007

Developmental Medicine &Amp; Child Neurology

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Baikie

South

Reddihough

et al. 2007

Developmental Medicine &Amp; Child Neurology

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show abstract

“…Though it has been reported that the salivagram is a sensitive test for salivary aspiration, there was only 26-28% prevalence of positive salivagrams in children suspected of aspiration seen in three retrospective studies. [25][26][27] Future studies are needed to compare the salivagram to BAL amylase in diagnosing aspiration of oral secretions.…”

Section: Figmentioning

confidence: 99%

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Abu-Hasan

ElMallah

Neal

et al. 2014

Pediatric Allergy, Immunology, and Pulmonology

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Background: Chronic pulmonary aspiration is a common cause of chronic respiratory symptoms in children. However, there is no gold standard diagnostic test for aspiration. In this study, we explore the diagnostic value of measuring salivary amylase in bronchoalveolar lavage (BAL) fluid as a marker of chronic aspiration in children with different chronic respiratory illnesses. Methods: Measurements of salivary amylase in BAL fluid were routinely done in patients undergoing flexible bronchoscopy. Patients' demographic and clinical data were extracted from records and reviewed by one of the investigators. Patients were classified into three different groups based on the reviewer's assessment of risk for aspiration. BAL amylase measurements were masked from the reviewer. Multiple regression analysis was used to determine the effect of the patients' clinical variables on BAL amylase. Results: Sixty-four patients (median age 2 years; range 0-14 years) were included. Indications for bronchoscopy included chronic cough (n = 20), chronic wheezing (n = 27), Cystic Fibrosis (n = 6), recurrent pneumonia (n = 5), and lung infiltrate in immunocompromised patients (n = 6). Young age, history of excessive drooling, and wet cough were predictive of high BAL amylase. Thirteen patients were considered at no risk of aspiration, 41 patients were at low risk, and 10 patients were at high risk based on clinical symptoms and other diagnostic tests. No significant differences in BAL amylase levels were found between the three groups. However, when high and low risk groups were combined and compared to the no risk group, there was a significantly higher BAL amylase level in the combined at risk groups (1,722 vs. 307 U/L; p = 0.03). Receiver operator curve analysis demonstrated that amylase cutoff value of 250 U/L differentiates between the two risk groups with sensitivity of 66.7% and specificity of 69.2%. Conclusion: Salivary amylase level in BAL can help identify children at risk for chronic pulmonary aspiration.

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“…Three retrospective reports [67][68][69] have shown a 26-28% prevalence of positive salivagrams in children suspected of aspiration, but no other confirmatory tests were performed. In one study evaluating the ability of salivagrams to predict the need for laryngotracheal separation, no correlation was found between salivagram result and days hospitalised owing to respiratory symptoms [70].…”

Section: Diagnosis Of Salivary Aspirationmentioning

confidence: 99%

Advances in the diagnosis and management of chronic pulmonary aspiration in children

Boesch

Daines

Willging

et al. 2006

European Respiratory Journal

158

141

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Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies.Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.

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Using the Radionuclide Salivagram to Detect Pulmonary Aspiration and Esophageal Dysmotility

Cited by 35 publications

References 0 publications

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

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

Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children

Advances in the diagnosis and management of chronic pulmonary aspiration in children

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