(460) Standardized Clinical Swallow Evaluation to Detect Aspiration in Infants

Introduction: The purpose was to perform a preliminary evaluation of a standardized clinical swallow evaluation (CSE) as an alternative to modified barium swallow (MBS) to identify aspiration in infants.

Methods: This observational case series was performed at a tertiary care children’s hospital Nov 2021-Oct 2022. Infants < 51 weeks PMA who underwent CSE and were scheduled for MBS were included. A standardized CSE was developed by expert consensus of 6 senior speech-language pathologists (SLP) including overt signs (2 items), behavioral/stress cues (13 items), work of breathing (3 items), complexion changes (2 items), vital signs (4 items), and noisy breathing (5 items). SLPs were also asked to indicate their concern for aspiration based upon assessed feeding only vs. incorporating medical history and observations of other feedings. Cohen’s k, sensitivity, and specificity of each CSE item for predicting aspiration on MBS were calculated.

Results: Median gestational age at birth was 35.7 weeks (range 23.7-40.0 weeks). On MBS, silent aspiration, aspiration with cough, and penetration were observed in 13 (59.1%), 0 (0.0%), and 6 (27.3%), respectively. Wet vocal quality was observed in 5 (38.5%) of those with silent aspiration vs 0 (0.0%) of those without (k=0.323, p=0.02, sensitivity 38.5%, specificity 100.0%). SLPs indicated concern for aspiration based on the assessed feeding in 8 (61.5%) of those with silent aspiration vs 1 (11.1%) of those without silent aspiration (k=0.472, p=0.009, sensitivity 61.5%, specificity 88.9%). When based on the infant’s overall clinical presentation, concern for aspiration was indicated in 13 (100.0%) of those with silent aspiration vs 5 (55.6%) of those without silent aspiration (k=0.486, p=0.004, sensitivity 100.0%, specificity 44.4%).

Conclusions: There was moderate agreement between SLP’s concern for aspiration during CSE and silent aspiration on MBS, with improved specificity with a standardized CSE compared with overall presentation. Wet vocal quality was present only in infants with silent aspiration. Future study with larger sample size is needed to validate a scoring system for CSE.