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Eating and Drinking Ability Classification System to detect aspiration risk in children with cerebral palsy: a
Ksenia M Bykova1, Ulrike Frank2, Gay L Girolami3,4
1College of Applied Health Sciences, University of Illinois at Chicago, 808 S. Wood St., Chicago, 60612, USA.
Insights
The Eating and Drinking Ability Classification System (EDACS) effectively identifies aspiration risk in children with cerebral palsy. Combining EDACS with the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) aids in decisions for swallowing studies.
Area of Science:
- Neurology
- Pediatrics
- Clinical Diagnostics
Background:
- Dysphagia affects approximately 50% of children with cerebral palsy.
- The Eating and Drinking Ability Classification System (EDACS) assesses eating and drinking efficiency and safety in children with cerebral palsy.
Purpose of the Study:
- To evaluate the concurrent validity of the EDACS for identifying aspiration risk in children with cerebral palsy, using the PEDI-EAT-10 as the reference.
- To explore the relationship between aspiration and non-aspiration groups using both EDACS and PEDI-EAT-10.
Main Methods:
- A prospective study involving 131 children with cerebral palsy and feeding problems.
- Concurrent validity assessed using the EDACS and the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10).
- Statistical analysis included correlation and ROC analysis to determine sensitivity and specificity.
Main Results:
- The EDACS demonstrated high specificity (92%) and sensitivity (78%) in identifying aspiration risk.
- A significant correlation (rs = 0.597, p < 0.001) was found between EDACS and PEDI-EAT-10 scores.
- Children classified in EDACS levels III-V were identified as being at risk for aspiration.
Conclusions:
- The EDACS is a valuable clinical tool for identifying aspiration risk in children with cerebral palsy.
- The study recommends using both EDACS and PEDI-EAT-10 for decisions regarding instrumental swallowing studies.
- EDACS levels III-V indicate a significant risk of aspiration.
Abstract:
This prospective study has two aims. The first aim is to assess the concurrent validity of the Eating and Drinking Ability Classification System (EDACS) as a means of identifying aspiration risk in children with cerebral palsy by using the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) as the reference test. The second aim is to investigate the relationship between the aspiration and non-aspiration groups using both the EDACS and the PEDI-EAT-10. Data were collected and analyzed from the EDACS and PEDI-EAT-10 using a convenience sample of 131 children with cerebral palsy and feeding problems (77 males, 54 females; median age 4.4 years [IQR 2.5 years]). Risk of aspiration was identified in 118 individuals using the PEDI-EAT-10 scores of ≥ 5 points. The EDACS proved to be a valid tool in identifying aspiration risk in children who are classified in EDACS levels III-V. There was a significant correlation between the EDACS and PEDI-EAT-10 (rs = 0.597, p < 0.001). The EDACS had 78% (95% CI = 71-86%) sensitivity and 92% (95% CI = 88-97%) specificity in identifying aspiration risk a positive predictive value of 0.99, a negative predictive value of 0.32, a positive likelihood ratio of 9.75, and a negative likelihood ratio of 0.24. Conclusion: The EDACS is a useful clinical tool to identify aspiration risk in children with cerebral palsy. Children in EDACS levels III to V are at risk of aspiration. As time permits, we recommend the use of both tools, the EDACS and the PEDI-EAT-10, when making decisions regarding referral for an instrumented swallowing study. What is Known: • Approximately 50% of children with cerebral palsy have dysphagia. • The Eating and Drinking Ability Classification System (EDACS) can be used to classify eating and drinking efficiency and safety in children with cerebral palsy. What is New: • Based on ROC analysis, EDACS demonstrates sensitivity of 78% and specificity of 92% in clinical identification of aspiration risk. • The combined use of the EDACS and the Pediatric version of the Eating Assessment Tool is recommended to make decisions about referral for an instrumented swallow study.
