Butterworth Sophie, Fitzsimons Kate J, Medina Jibby, Britton Lorraine, Van Eeden Stephanie, Wahedally Hussain, Park Min Hae, van Der Muelen Jan, Russell Craig J H
Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK.
Trent Regional Cleft Network, Nottingham University Hospital NHS Trust, Nottingham, UK.
Cleft Palate Craniofac J. 2023 Dec;60(12):1578-1590. doi: 10.1177/10556656221110094. Epub 2022 Jun 22.
To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ± lip (CP ± L). 3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland. Perceptual speech analysis utilized the Cleft Audit Protocol for Speech-Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)-speech within the normal range, SS2a-no structurally related speech difficulties or history of speech surgery, and SS3-speech without significant cleft-related articulation difficulties. Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP-aOR 0.719 [CI 0.591-0.875]; BCLP-aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete-aOR 0.701 [CI 0.540-0.909]; complete-aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent. Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.
为了研究腭裂伴或不伴唇裂（CP±L）患儿的患者相关因素（性别、腭裂类型、腭裂范围和罗宾序列[RS]）与5岁时言语结果之间的关系。3157名非综合征性CP±L患儿（1426名女性：1731名男性），于2006年至2014年在英格兰、威尔士和北爱尔兰出生。感知言语分析采用言语增强腭裂评估方案（CAPS-A）评分和英国国家言语结果标准：言语标准1（SS1）——言语在正常范围内，SS2a——无结构相关言语困难或言语手术史，以及SS3——无明显腭裂相关发音困难。达到SS1的几率在男孩中较低（调整后比值比[aOR]0.771[可信区间（CI）0.660 - 0.901]），唇腭裂患儿（与仅腭裂患儿相比）（双侧完全性腭裂-UCLP：aOR 0.719[CI 0.591 - 0.875]；双侧不完全性腭裂-BCLP：aOR 0.360[CI 0.279 - 0.463]），以及硬腭裂患儿（不完全性-aOR 0.701[CI 0.540 - 0.909]；完全性-aOR 0.393[CI 0.308 - 0.501]）。对于SS3，观察到与这些患者因素有类似关系。SS2受硬腭受累程度影响（完全性；aOR 0.449[CI 0.348 - 0.580]）。虽然与无RS的患儿相比，患有CP和RS的患儿不太可能达到所有3项标准，但在调整性别和腭裂范围后，比值比无统计学意义。性别、腭裂类型和硬腭受累程度对5岁时的言语结果有显著影响。建议将这些因素纳入服务水平结果报告的风险调整模型中。
