Validation of Clinical Assessment for Diagnosing Dysphagia in Infants with Chronic Encephalopathy

Objectives: To verify the validity of clinical assessment in diagnosing dysphagia in children with chronic encephalopathy. Methods: We included 93 clinical swallowing exams associated with video fluoroscopy performed in children diagnosed with chronic encephalopathy, aged between two and five years, from an institution’s database from March 2010 to September 2011. Evaluations were performed on two separate occasions, by different researchers under blind conditions.

Results: Clinical assessment presented low sensitivity (65,4%) and a positive predictive value (59,6%) in relation to video fluoroscopy for diagnosing dysphagia with liquid consistency. Specificity was low, with levels under (47.9%) for the consistencies tested. A weak concordance was observed (Kappa 0.2) between the clinical assessment and videofluoroscopy for pasty consistency. No statistically significant difference was observed between the studied methods (p>0.05).

Conclusion: In the present study, the sensitivity and specificity of the clinical diagnosis of dysphagia have demonstrated that this diagnostic procedure may not detect any change in the swallowing process, irrespective of the consistency used during investigation.

Keywords: Swallowing disorders; Videofluoroscopy; Cerebral palsy; Sensitivity and specificity; Clinical diagnosis