title: Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Oropharyngeal aspiration (OPA) can lead to recurrent respiratory illnesses and chronic lung disease in children. Current clinical feeding evaluations performed by speech pathologists have poor reliability in detecting OPA when compared to radiological procedures such as the modified barium swallow (MBS). Improved ability to diagnose OPA accurately via clinical evaluation potentially reduces reliance on expensive, less readily available radiological procedures. Our study investigates the utility of adding cervical auscultation (CA), a technique of listening to swallowing sounds, in improving the diagnostic accuracy of a clinical evaluation for the detection of OPA.
  
  
  METHODS
  We plan an open, unblinded, randomised controlled trial at a paediatric tertiary teaching hospital. Two hundred and sixteen children fulfilling the inclusion criteria will be randomised to one of the two clinical assessment techniques for the clinical detection of OPA: (1) clinical feeding evaluation only (CFE) group or (2) clinical feeding evaluation with cervical auscultation (CFE + CA) group. All children will then undergo an MBS to determine radiologically assessed OPA. The primary outcome is the presence or absence of OPA, as determined on MBS using the Penetration-Aspiration Scale. Our main objective is to determine the sensitivity, specificity, negative and positive predictive values of 'CFE + CA' versus 'CFE' only compared to MBS-identified OPA.
  
  
  CONCLUSIONS
  Early detection and appropriate management of OPA is important to prevent chronic pulmonary disease and poor growth in children. As the reliability of CFE to detect OPA is low, a technique that can improve the diagnostic accuracy of the CFE will help minimise consequences to the paediatric respiratory system. Cervical auscultation is a technique that has previously been documented as a clinical adjunct to the CFE; however, no published RCTs addressing the reliability of this technique in children exist. Our study will be the first to establish the utility of CA in assessing and diagnosing OPA risk in young children.
  
  
  BACKGROUND
  Australia and New Zealand Clinical Trials Register (ANZCTR) number ACTRN12613000589785.
authors.affiliation: Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia. t.frakking@uq.edu.au.
authors.forename: Thuy T
authors.initials: TT
authors.lastname: Frakking
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.forename: Kerry-Ann F
authors.initials: KA
authors.lastname: O'Grady
authors.forename: Katie
authors.initials: K
authors.lastname: Walker-Smith
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Weir
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001314:Auscultation / Q000379:methods*; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003287:Contrast Media; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011793:Queensland; D012107:Research Design; D062606:Tertiary Care Centers
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate