Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA.
Intermountain Primary Children's Hospital, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA.
Cleft Palate Craniofac J. 2021 Apr;58(4):479-488. doi: 10.1177/1055665620954063. Epub 2020 Oct 5.
To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment.
Retrospective cohort setting; tertiary children's hospital patients; children with cleft palate repair identified through procedure codes.
Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with test. Multivariate linear and logistic regression adjusted for confounding variables.
Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care ( < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis ( < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI ( < .001) and 20% increased odds of receiving speech surgery ( < .001). Age at VPI diagnosis and speech surgery were similar between groups ( = .55 and .29).
Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated.
Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.
评估美国腭裂颅面协会（ACPA）认可的多学科团队对腭咽闭合不全（VPI）诊断和治疗的影响。
回顾性队列研究；三级儿童医院患者；通过手术代码确定腭裂修复患者。
根据外科医生或团队评估分配腭咽闭合不全诊断。记录诊断和手术的年龄。采用卡方检验分析年龄和 VPI 诊断及手术率的差异。采用多元线性和逻辑回归校正混杂因素。
共纳入 940 例患者，其中 71.5%接受 ACPA 认可的多学科团队治疗。与独立治疗组（10%）相比，团队治疗组（38.8%）更多患者被诊断为 VPI（<0.001）。团队治疗与 VPI 诊断增加近 6 倍相关（<0.001）。团队治疗与更高比例的语音手术相关（21%比 10%，<0.001）。在接受团队治疗的儿童中，每次就诊与 VPI 诊断的可能性增加 25%（<0.001）和语音手术的可能性增加 20%（<0.001）相关。VPI 诊断和语音手术的年龄在两组之间相似（=0.55 和 0.29）。
团队治疗与 VPI 更准确的检测相关，从而导致更多的 VPI 语音治疗就诊和手术管理。更多的团队就诊同样与 VPI 相关。
建议进一步研究 VPI 及时准确诊断的临床意义，包括生活质量评估，为团队就诊和评估计划提供更有力的指导。
