Influence of framerate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow study – an observational study
Tracks
Concurrent session T5
Acute care – paediatric
Assessment
Dysphagia
Feeding
Infant feeding
Paediatric/Infant
VFSS (videofluroscopy)
| Tuesday, May 28, 2024 |
| 11:30 AM - 11:45 AM |
| River View Room 05 |
Overview
Thuy Frakking
Details
⏫ Research insights
📚 Assumed knowledge of attendees: Intermediate (some previous learning/working knowledge of topic e.g. treated a few cases)
📚 Assumed knowledge of attendees: Intermediate (some previous learning/working knowledge of topic e.g. treated a few cases)
Presenter
Assoc Professor Thuy Frakking
A/Research Director & Advanced Speech Pathologist
Caboolture Hospital & Gold Coast University Hospital
Influence of framerate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow study – an observational study
11:30 AM - 11:45 AMPresentation summary
Background: The videofluoroscopic swallow study (VFSS), currently considered the gold standard for assessing aspiration in children, requires radiation. Adhering to the ‘as low as reasonably achievable’ (ALARA)’ principal is crucial in minimising radiation dosage while obtaining accurate diagnostic information, especially in children. International adult VFSS guidelines recommend a capture rate of 30 frames per second (fps). Higher capture rates increases radiation yet there is limited evidence on best practice x-ray capture rates in children, particularly on thin fluid consistency – the fastest viscosity with the highest potential for missed aspiration on 15fps.
Aim: To determine if image acquisition at 30fps versus 15fps for paediatric VFSS when assessing thin fluid consistency alters the accuracy of detecting aspiration.
Methods: Seventeen speech language pathologists (SLPs) across Australia and New Zealand with >2 years paediatric dysphagia experience were recruited. They rated 76 VFSS recordings of infants and children drinking thin fluids for the presence or absence of aspiration of each VFSS recording on 2 separate occasions electronically in a blinded manner. Each VFSS recording was randomly presented at 15 versus 30fps. An experienced SLP and paediatric radiologist used the penetration-aspiration scale to rate aspiration to form the source of truth for binary ratings (present/absent). Areas under receiver operating characteristic curves (aROCs) were used to compare the accuracy of aspiration ratings at 15 versus 30fps. The intraclass correlation coefficient was used to examine rater reliability.
Results: The accuracy for detecting aspiration is similar at 15fps (aROC=0.97; 95%CI 0.96-0.97) and 30fps (aROC=0.96; 95%CI 0.96-0.97). Good inter-rater (ICC=0.82; 95%CI: 0.72–0.89) and intra-rater reliability among the raters (ICC=0.89; 95%CI 0.82–0.93) was found.
Conclusions: Using 15fps in paediatric VFSS when assessing for thin fluid consistency aspiration provides a similar detection rate to using 30fps.
Aim: To determine if image acquisition at 30fps versus 15fps for paediatric VFSS when assessing thin fluid consistency alters the accuracy of detecting aspiration.
Methods: Seventeen speech language pathologists (SLPs) across Australia and New Zealand with >2 years paediatric dysphagia experience were recruited. They rated 76 VFSS recordings of infants and children drinking thin fluids for the presence or absence of aspiration of each VFSS recording on 2 separate occasions electronically in a blinded manner. Each VFSS recording was randomly presented at 15 versus 30fps. An experienced SLP and paediatric radiologist used the penetration-aspiration scale to rate aspiration to form the source of truth for binary ratings (present/absent). Areas under receiver operating characteristic curves (aROCs) were used to compare the accuracy of aspiration ratings at 15 versus 30fps. The intraclass correlation coefficient was used to examine rater reliability.
Results: The accuracy for detecting aspiration is similar at 15fps (aROC=0.97; 95%CI 0.96-0.97) and 30fps (aROC=0.96; 95%CI 0.96-0.97). Good inter-rater (ICC=0.82; 95%CI: 0.72–0.89) and intra-rater reliability among the raters (ICC=0.89; 95%CI 0.82–0.93) was found.
Conclusions: Using 15fps in paediatric VFSS when assessing for thin fluid consistency aspiration provides a similar detection rate to using 30fps.
Key messages
•There is limited evidence on best practice x-ray capture rates in paediatric videofluroscopic swallow studies, particularly on thin fluid consistency.
•The accuracy for detecting aspiration is similar at 15 and 30 frames per second for thin fluid consistency, with good inter- and intra-rater reliability among speech language pathologists.
•Use of 15 frames per second in paediatric videofluoroscopic swallow studies is recommended for the detection of aspiration on thin fluids
•The accuracy for detecting aspiration is similar at 15 and 30 frames per second for thin fluid consistency, with good inter- and intra-rater reliability among speech language pathologists.
•Use of 15 frames per second in paediatric videofluoroscopic swallow studies is recommended for the detection of aspiration on thin fluids
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Dr Frakking is an Advanced Speech Pathologist (Paediatrics) at Gold Coast University Hospital, Metro North Health Clinician Research Fellow and Research Director at Caboolture Hospital.
She is the top-most prolific author in Australia and ranked 8th internationally in the field of cervical auscultation. Her PhD work on cervical auscultation has been cited in guidelines by 58 institutions nationally and internationally; and includes a position statement for the Latin America Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during COVID-19 pandemic. She has attracted >$1.7 million in research funding, including a MRFF grant focussing on the application of machine learning techniques with cervical auscultation to improve the accurate detection of aspiration in neonates and children.
Her research interests include translational paediatric research that focuses on improving and implementing more accurate and accessible assessments for infants and children with feeding disorders and chronic non-complex medical conditions.
Session chair
Mary Claessen
Senior Advisor Professional Standards
Speech Pathology Australia
Student volunteer(s)
Lillian Hennessy-Ellis
Student
Curtin University
Tanvi Patel
Curtin University
The information contained in this program is current at of the time of publishing but is subject to changes made without notice.
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