Predictive Factors in Identifying Pediatric Patients at Risk of Diagnostically Limited Videofluoroscopic Swallow Studies

Abstract

Objective: Videofluoroscopic swallow studies (VFSS) are highly effective in characterizing pediatric dysphagia, but they are time- and resource-intensive, and necessitate the use of radiation. Identifying patients unlikely to benefit from VFSS is crucial to improving patient safety and resource allocation. The purpose of this study was to assess whether the ability of a patient to consume at least 0.5 oz by mouth is a reliable indicator of their ability to produce a diagnostically useful VFSS. Study Design: Retrospective chart review. Methods: Clinical data of pediatric patients aged 0 to 18 years, who underwent VFSS at a tertiary academic medical center from 2014 to 2021 were analyzed. Results: Regardless of whether due to mechanical dysphagia or oral aversion, an inability to consume at least 0.5 oz of any texture by mouth at home was not found to be associated with nondiagnostic VFSS. Age was found to have an effect on VFSS utility with toddlers having higher odds of nondiagnostic VFSS compared to children and adolescents. Overall, there was no significant interaction between the ability to take at least 0.5 oz and age group. Gastrointestinal (GI) and neuromuscular comorbidities were also associated with clinically useful swallow studies. Conclusions and Relevance: Clinicians should consider several factors, including age, at-home intake by mouth, and comorbidities such as neuromuscular and GI disorders, as they decide whether to order a VFSS.