572 - Variation in Swallow Function Evaluations in Children After Ventilatory Support for Acute Respiratory Illness in U.S. Children’s Hospitals

Publication Number: 2557.572

Vidya Menon, Baylor College of Medicine, Houston, TX, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Jessica Markham, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Ronald J. Teufel II, UC, San Diego/Rady Health, San Diego, CA, United States; John Stephens, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Marina Dantas, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Smit Shah, Children's Mercy Hospitals and Clinics, kansas city, MO, United States; Taryn E. Townsend, Texas Children's Hospital, Houston, TX, United States; Michael J. Steiner, Oklahoma Childrens Hospital at OU Health, Chapel Hill, NC, United States; Nikhila Raol, Baylor College of Medicine, Houston, TX, United States; Matthew Molloy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katelyn Butler, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Sowdhamini S. Wallace, Baylor College of Medicine, Houston, TX, United States

Background: Post-extubation dysphagia (PeD) is a known complication following discontinuation of prolonged mechanical ventilation. It is associated with acute and chronic morbidities such as aspiration pneumonia, prolonged hospitalization, and need for enteric feeding tubes. However, there is limited evidence describing the risk of PeD and the need for swallow evaluation in previously healthy children after extubation.

Objective: We aimed to 1) measure the frequency of clinical and radiographic swallow function evaluations obtained for post-extubated patients across children's hospitals and 2) compare clinical outcomes for patients based on the type of swallowing evaluation received.

Design/Methods: We conducted a multicenter retrospective cohort study using the Pediatric Health Information System database, including patients aged 0 days-17 years who required mechanical ventilation in a pediatric intensive care unit from 1/2016 to 12/2024 (Fig. 1). Patients were categorized into 3 evaluation categories: no swallow evaluation, bedside swallow evaluation (BSE) only, or BSE + videofluoroscopic swallow study (VFSS)/fiberoptic endoscopic evaluation of swallowing (FEES). The primary outcome was a composite measure of aspiration-related comorbidities within 30 days of discharge (e.g., aspiration-related readmission or emergency department (ED) revisits). Secondary outcomes included all-cause readmissions/ED revisits, index hospitalization length of stay (LOS), and cost of index hospitalization. Outcomes were modeled using generalized estimating equations adjusting for age, sex, payor, H-RISK and clustered on hospital site.

Results: We included 5876 patients across 39 children's hospitals; the majority had respiratory failure due to bronchiolitis (75.5%) with a median of 3 days intubation (Table 1). There was wide interhospital variation in swallow evaluations; individual hospitals had a median of 71.8% (range 50-97.7%) for no swallow evaluation, 24.5% (range 1.7 -87.8%) for BSE only, and 3.7% (range 0-33.3%) for BSE + VFSS/FEES. In adjusted analyses, patients that received BSE + VFSS/FEES had greater hospital LOS, cost, and subsequent aspiration-related comorbidities compared to those in the BSE only or no swallow evaluation groups (Table 2).

Conclusion(s): For post-intubated pediatric patients with acute respiratory illness, we identified wide variation in the frequency of clinical bedside and radiographic swallow function evaluations. Further studies are needed to better understand the reasons for the association between BSE + VFSS/FEES and worse clinical outcomes, and to also standardize the testing approach.

Figure 1: Inclusion and Exclusion Criteria


Table 1: Comparison of Patients and Illness Management Characteristics Based on Tier of Swallow Evaluation Received


Table 2: Adjusted Outcomes Based on Tier of Evaluation Received
Outcomes adjusted for age, sex, payor, H-risk, and clustered on hospital site