DeMatteo Carol, Matovich Diana, Hjartarson Aune
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Dev Med Child Neurol. 2005 Mar;47(3):149-57. doi: 10.1017/s0012162205000289.
The objectives of this study were threefold: (1) to evaluate the accuracy of clinical evaluation compared with videofluoroscopic swallowing studies (VFSSs) in the detection of penetration and aspiration in children of age 0 to 15 years presenting with feeding and swallowing problems; (2) to assess the relationship between therapists' confidence ratings in making judgements about the presence or absence of penetration and aspiration, and the accuracy of their evaluation as confirmed by VFSSs; (3) to identify clinical predictors of penetration and aspiration during clinical evaluation of children with feeding and swallowing difficulties. We used a prospective study to evaluate the sensitivity, specificity, and positive and negative predictive values of a diagnostic clinical evaluation compared with VFSSs (criterion standard). Clinical evaluation and videofluoroscopy forms for oral motor and swallowing evaluation, which included potential indicators of aspiration, were designed for this project. Seventy-five children with feeding problems participated (33 females, 42 males; age range 0 to 14 years, mean 2 years; 62% of participants younger than 12 months). For fluids, clinical evaluation showed a sensitivity of 92% for aspiration. For solids, sensitivity for detecting aspiration was 33%. Analysis of the therapists' mean confidence ratings compared with the accuracy of their judgement demonstrated that when therapists were very sure that the child was aspirating or penetrating or not, they were correct. When the therapists were unsure, then the accuracy of prediction was not as good. Cough was the most significant predictor (p < 0.05) of fluid aspiration and penetration. We conclude that clinical evaluation with experienced clinicians can detect aspiration and penetration of fluids in children of varied ages and diagnoses, but that it is not accurate with solids.
（1）评估对于存在喂养和吞咽问题的0至15岁儿童，临床评估与视频荧光吞咽造影检查（VFSS）在检测渗透和误吸方面的准确性；（2）评估治疗师在判断是否存在渗透和误吸时的信心评级与VFSS所证实的评估准确性之间的关系；（3）确定在对有喂养和吞咽困难的儿童进行临床评估时渗透和误吸的临床预测因素。我们采用前瞻性研究来评估与VFSS（标准参照）相比，诊断性临床评估的敏感性、特异性、阳性和阴性预测值。为此项目设计了用于口腔运动和吞咽评估的临床评估及视频荧光造影检查表格，其中包括误吸的潜在指标。75名有喂养问题的儿童参与研究（33名女性，42名男性；年龄范围0至14岁，平均2岁；62%的参与者年龄小于12个月）。对于液体，临床评估显示误吸的敏感性为92%。对于固体食物，检测误吸的敏感性为33%。将治疗师的平均信心评级与其判断准确性进行分析表明，当治疗师非常确定儿童是否正在误吸、渗透或未发生时，他们的判断是正确的。当治疗师不确定时，预测准确性则没那么好。咳嗽是液体误吸和渗透的最显著预测因素（p<0.05）。我们得出结论，由经验丰富的临床医生进行临床评估可以检测不同年龄和诊断的儿童的液体误吸和渗透情况，但对于固体食物则不准确。
