Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review. (9th February 2016)

• Record Type: Journal Article
• Authors: Calvo, Irene; Conway, Aifric; Henriques, Filipa; Walshe, Margaret
• Is Part Of: Developmental medicine & child neurology. Volume 58:Number 6(2016:Jun.)
• Page Start: 541
• Page End: 553
• Publication Date: 2016-02-09
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.13058
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract : The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision‐making and to provide safe, cost‐effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre‐optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS‐2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well‐designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics. What this paper adds: Reviews the evidence on diagnostic accuracy of paediatric clinical feeding examinations (CFEs) for detecting aspiration. Suggests using liquids rather than solids to enhance CFE sensitivity. Identifies a critical lack of evidence on accuracy of paediatric CFEs. Directs further research on diagnostic accuracy of CFE using different consistencies. This article is commented on by Sellers on page530 of this issue.