Frakking Thuy T, Chang Anne B, O'Grady Kerry-Ann F, David Michael, Weir Kelly A
a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia.
b Speech Pathology Department , Caboolture Hospital , Brisbane , Australia.
Int J Speech Lang Pathol. 2017 Dec;19(6):569-577. doi: 10.1080/17549507.2016.1222452. Epub 2016 Sep 29.
Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment.
This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score).
Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79-0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72-0.98). Overall sensitivity was 93.9% (95%CI 91.8-95.6) and specificity was 94.5% (95%CI 92.5-96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone.
Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice.
支持在儿童中使用颈部听诊（CA）的可重复性的数据有限。本研究旨在确定在可控环境下CA检测儿童口咽性误吸（OPA）的可靠性。
这项观察性研究包括8名言语病理学家，他们在两个不同的场合对40个正常吞咽声音片段和40个OPA吞咽声音片段进行评分（即每位言语病理学家对160个声音片段进行评分），共计1280个吞咽片段被评分。吞咽声音片段收集自：（1）从普通社区招募的20名健康儿童志愿者样本（平均16.2±10.7个月；65%为女性）；（2）19名经视频荧光吞咽造影研究（VFSS）使用渗透-误吸量表（PAS）（≥6分）确定存在OPA的转诊儿童样本（平均22.8±25.5个月；36.8%为女性）。
评分者间信度非常好（kappa=0.81，95%CI 0.79-0.84）。每位评分者的评分者内信度为良好至非常好（kappa范围0.72-0.98）。总体敏感性为93.9%（95%CI 91.8-95.6），特异性为94.5%（95%CI 92.5-96.2）。单独使用CA检测OPA与正常吞咽时发现了较高的可靠性值。
在提倡将CA用于常规临床实践之前，未来的研究应在环境控制较少的各种临床环境中研究CA的使用情况。
