Soyer Tutku, Yalcin Sule, Arslan Selen Serel, Demir Numan, Tanyel Feridun Cahit
Hacettepe University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
Hacettepe University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
J Pediatr Surg. 2017 Oct;52(10):1576-1579. doi: 10.1016/j.jpedsurg.2017.02.018. Epub 2017 Mar 14.
Airway aspiration is a common problem in children with esophageal atresia (EA). Pediatric Eating Assessment Tool-10 (pEAT-10) is a self-administered questionnaire to evaluate dysphagia symptoms in children. A prospective study was performed to evaluate the validity of pEAT-10 to predict aspiration in children with EA.
Patients with EA were evaluated for age, sex, type of atresia, presence of associated anomalies, type of esophageal repair, time of definitive treatment, and the beginning of oral feeding. Penetration-aspiration score (PAS) was evaluated with videofluoroscopy (VFS) and parents were surveyed for pEAT-10, dysphagia score (DS) and functional oral intake scale (FOIS). PAS scores greater than 7 were considered as risk of aspiration. EAT-10 values greater than 3 were assessed as abnormal. Higher DS scores shows dysphagia whereas higher FOIS shows better feeding abilities.
Forty patients were included. Children with PAS greater than 7 were assessed as PAS+ group, and scores less than 7 were constituted as PAS- group. Demographic features and results of surgical treatments showed no difference between groups (p>0.05). The median values of PAS, pEAT-10 and DS scores were significantly higher in PAS+ group when compared to PAS- group (p<0.05). The sensitivity and specificity of pEAT-10 to predict aspiration were 88% and 77%, and the positive and negative predictive values were 22% and 11%, respectively. Type-C cases had better pEAT-10 and FOIS scores with respect to type-A cases, and both scores were statistically more reliable in primary repair than delayed repair (p<0.05). Among the postoperative complications, only leakage had impact on DS, pEAT-10, PAS and FOIS scores (p<0.05).
The pEAT-10 is a valid, simple and reliable tool to predict aspiration in children. Patients with higher pEAT-10 scores should undergo detailed evaluation of deglutitive functions and assessment of risks of aspiration to improve safer feeding strategies.
Level II (Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard").
气道误吸是食管闭锁（EA）患儿的常见问题。儿童饮食评估工具-10（pEAT-10）是一种用于评估儿童吞咽困难症状的自填式问卷。本前瞻性研究旨在评估pEAT-10预测EA患儿误吸的有效性。
对EA患儿进行年龄、性别、闭锁类型、合并畸形情况、食管修复类型、确定性治疗时间及开始经口喂养时间的评估。通过电视荧光吞咽造影检查（VFS）评估穿透-误吸评分（PAS），并对家长进行pEAT-10、吞咽困难评分（DS）及功能性经口摄食量表（FOIS）的调查。PAS评分大于7被视为有误吸风险。pEAT-10值大于3被评估为异常。DS评分越高表明吞咽困难，而FOIS评分越高表明喂养能力越好。
纳入40例患者。PAS大于7的儿童被评估为PAS+组，评分小于7的儿童构成PAS-组。两组间的人口统计学特征和手术治疗结果无差异（p>0.05）。与PAS-组相比，PAS+组的PAS、pEAT-10和DS评分中位数显著更高（p<0.05）。pEAT-10预测误吸的敏感性和特异性分别为88%和77%，阳性预测值和阴性预测值分别为22%和11%。C型病例的pEAT-10和FOIS评分相对于A型病例更好，且在一期修复中这两个评分在统计学上比延迟修复更可靠（p<0.05）。在术后并发症中，只有吻合口漏对DS、pEAT-10、PAS和FOIS评分有影响（p<0.05）。
pEAT-10是预测儿童误吸的有效、简单且可靠的工具。pEAT-10评分较高的患者应接受详细的吞咽功能评估和误吸风险评估，以制定更安全的喂养策略。
二级（在一系列连续患者中制定诊断标准并采用通用的“金标准”）
