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A3646 - Processes of Care and Clinical Management of Children with Aspiration
Author Block: L. Midyat1, F. Dy2, W. Wong3, K. Haver1; 1Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, United States, 2Division of Pulmonary, University of California, San Francisco, San Francisco, CA, United States, 3Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
RATIONALE: Pulmonary aspiration in infants and children are common, with 25 % of the pediatric population reported to experience some type of nonspecific feeding difficulty. Diagnosing and managing aspiration remains a challenging task due to the lack of distinguishing clinical or laboratory characteristics. We conducted a large, physician-based study in an effort to determine the differences in the diagnosis and management of patients with aspiration across different centers, using a quantitative online questionaire. METHODS: The survey was constructed to understand current practice trends related to aspiration lung disease in children. The questions cover physician demographics, diagnosis, management strategies and the role of specialized centers for airway, voice and swallowing disorders (also known as Aerodigestive Disease Centers). The questionnaire was sent to the pediatric membership of the American thoracic society. RESULTS: A total of 136 questionnaires were retrieved from pediatric ATS members between June and September 2015. Physicians from 42 different aerodigestive centers participated in the survey. Ninety-two percent of respondents believed that the evidence is unclear on the best methods for diagnosing aspiration lung disease. Modified barium swallow study (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES) were the most useful studies in making the diagnosis of the aspiration according to the participants. The majority of the participants preferred to repeat the feeding evaluations and modified barium swallow after the initial intervention. For children with suspected or confirmed aspiration, 68.6% of the respondents stated that they do combine endoscopy and flexible and/or rigid bronchoscopy for further evaluation, while 27.1% preferred to perform the procedures individually at the discretion of each specialty provider. Inhaled corticosteroids were mostly prescribed if there was any component of bronchial hyperreactivity, and acid suppression therapy was primarily prescribed if there was a diagnosis or suspicion of gastroesophageal reflux disease. Empirical thickening of the feeds was not uniformly performed among the aerodigestive centers as a therapy method for the children with aspiration. CONCLUSION: In the survey, physicians mentioned about the importance of better guidelines for aspiration, the requirement of new diagnostic measures and the necessity of multicenter trials of sensitivity and specificity of current diagnostic tools and developing a scoring system for reading the radiological studies for children with aspiration. Additional research efforts will provide the needed data to guide future management and intervention protocols.