Clinical feeding evaluation
All children were initially assessed clinically by the OT, following
referral from a number of sources, including hospital departments,
outpatient clinics and community settings. The case notes of those
assessments were reviewed by an experienced OT for this study. The
eight-point penetration-aspiration score, validated and previously used
in children10, 11 was converted into a simplified
format, as previously described,6 to facilitate
comparison between CFE and VFSS and calculation of the predictive value
of CFE with respect to the presence of suspected overt or silent
aspirations, as compared to the VFSS gold standard (table 1). For this
purpose, penetration was regarded as no aspiration. The presence of
aspirations was noted separately for each texture trialed. However, in
the final diagnosis, aspiration referred to a positive finding for one
or more food textures. Silent aspiration (SA) was suspected and scored
clinically when there were anamnestic clues and subtle signs, such as a
wet/ phlegmy vocal quality, lack of speech, a decrease in alertness,
drooling, difficulty controlling secretions and an absent gag
reflex.12