Authors (including presenting author) :
YIU OY (1), SIU KY (2), CHOI KY (1), LO FW (3), FONG R (2)
Affiliation :
(1)Speech Therapy Unit, Department of Allied Health, Hong Kong Children's Hospital, (2)Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, (3)Department of Ear, Nose and Throat, Hong Kong Children's Hospital.
Introduction :
Fiberoptic endoscopic evaluation of swallowing (FEES) provides direct visualization of the anatomy and physiology required for swallowing. FEES has been used in adult patients since 1988 and internationally in children. There is a lack of standardized protocol for FEES procedure and documentation in children locally, such would be important for setting up services and comparing outcomes among hospitals.
Objectives :
This study was aimed at systematically evaluating the collaborative Otorhinolaryngology (ENT) and Speech Therapy (ST) pediatric FEES examinations performed at Hong Kong Children’s Hospital (HKCH) since its inception. The findings were then to guide subsequent setting up of the pediatric FEES clinic and serve as a service planning model that is locally applicable.
Methodology :
A retrospective analysis of 18 FEES examinations performed from October 2019 to August 2021 was done. The demographics of the patients, FEES reports and post-FEES progress notes by ENT and ST were retrieved. The FEES reports were reviewed independently by two STs using a binary rating system for presence or absence of items to be documented in FEES examination based on the protocol used by Cincinnati Children’s Hospital Medical Center. Assessment protocol with documentation guideline was later implemented along with the commencement of the FEES clinic in September 2021. Clinical audit on FEES reports documentation was done in four examinations in the subsequent two months, with the same methodology. Descriptive analysis was performed for all the data.
Result & Outcome :
Half of the patients were below one-year-old and 61% were female. Oncological disorders with underlying neurological impairments were the most common primary diagnosis (50%). Complication rate was 5% (1/18) with desaturation 2 hours post-FEES with escalations of care required. Items under the four examining sections of standard protocol were addressed in the FEES documentation with the reporting rates ranging from 6% to 100%. Some items were described in detail with rates up to 92% (e.g. location of pharyngeal residue), while some other details were lacking (e.g. amount of aspiration). Reporting rates were improved to 100% for all items after the standard protocol was in place, along with detailed documentation on swallowing parameters. Findings indicated FEES is feasible in infants and older children with a low complication rate in HKCH. Standard protocol implemented in the clinic effectively enhanced clinical documentation and thus facilitated clinical care of patients with dysphagia, and would serve as a reference of service for other hospitals.
