PAS: Swallow test may raise respiratory infection risk in infants

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]