Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children.
OBJECTIVE
To compare videofluoroscopy swallowing study (VFSS) with the fiberoptic endoscopic evaluation of swallowing (FEES) in children and to determine the accuracy of FEES in the diagnosis of specific swallowing disorders.


METHODS
Cross-sectional study.


METHODS
Hospital da Criança Santo Antônio, affiliated with Santa Casa de Misericórdia Hospital Complex, Porto Alegre, RS, Brazil.


METHODS
FEES findings were compared to those of VFSS in 30 children. Kappa coefficients for interobserver agreement were calculated. Thereafter, these coefficients were evaluated in terms of agreement between FEES and VFSS. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of FEES were calculated for four swallowing parameters (posterior spillover, pharyngeal residues, laryngeal penetration, and laryngotracheal aspiration).


RESULTS
Interobserver agreement rates greater than 70 percent were obtained for all FEES parameters analyzed, except for pharyngeal residues with puree consistency (agreement = 66.7%, kappa = 0.296, P = 0.091). Laryngeal aspiration and penetration yielded the best level of agreement (100%, kappa = 1) for the laryngeal aspiration of puree residues.


CONCLUSIONS
The diagnostic agreement between FEES (both observers) and VFSS was low. Regarding the analyzed parameters, laryngeal penetration and aspiration yielded the highest interobserver agreement in terms of FEES, and also showed the highest specificity and positive predictive value when compared to VFSS.
da Silva
Andréa P
AP
Post-Graduate Program, School of Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. deapsilva@gmail.com
Lubianca Neto
José F
JF
Santoro
Patrícia Paula
PP
D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation*; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014741:Video Recording