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Validity, Reliability and Application of the Paediatric Posterior Drooling Scale
Denise C R M Koeken1, Karen van Hulst2, Marloes L J Lagarde2
1Rijndam Rehabilitation, Rotterdam, the Netherlands.
Insights
The Paediatric Posterior Drooling Scale (PPDS) is a valid and reliable tool for speech-language pathologists to screen posterior drooling in children with neurological disorders. This non-invasive method aids in early detection and management, reducing respiratory complications.
Area of Science:
- Pediatric Neurology
- Speech-Language Pathology
- Clinical Assessment Tools
Background:
- Posterior drooling is a common issue in children with neurological disorders, often linked to oropharyngeal dysphagia.
- Early identification and management are crucial for reducing associated respiratory complications.
Purpose of the Study:
- To evaluate the construct validity, inter-rater, and intra-rater reliability of the novel Paediatric Posterior Drooling Scale (PPDS).
- To assess the clinical applicability of the PPDS as a screening tool for posterior drooling in pediatric patients.
Main Methods:
- A cross-sectional observational study involving 69 children (aged 1-18 years) with central neurological disorders.
- Cervical auscultation (CA) was performed by trained speech-language therapists (SLTs).
- Convergent construct validity was assessed using the Functional Oral Intake Scale (FOIS) and the Eating and Drinking Ability Classification System (EDACS).
Main Results:
- The PPDS demonstrated moderate negative correlation with FOIS (rho=-0.54, p<0.001) and moderate positive correlation with EDACS (rho=0.70, p<0.001).
- Excellent intra-rater reliability (ICC=0.91, p<0.001) and good inter-rater reliability (ICC=0.85, p<0.001) were observed.
- High test-retest reliability was noted, with 84% agreement for a score of 0.
Conclusions:
- The PPDS is a valid, reliable, and clinically applicable tool for SLTs to screen posterior drooling non-invasively.
- Efficient identification of posterior drooling via PPDS can improve clinical management and reduce respiratory issues.
- The PPDS serves as a bridge to instrumental assessment, guiding further diagnostic steps for pediatric posterior drooling.
Aims:
This study aims to assess the construct validity, inter-rater and intra-rater reliability and application of the newly developed Paediatric Posterior Drooling Scale (PPDS), a novel clinical screening tool that uses cervical auscultation (CA) to evaluate posterior drooling in children with neurological disorders.
Methods:
In this cross-sectional observational study, 69 children with central neurological disorders aged 1-18 years (mean 8.4 years, 50 males, 19 females) were included for analysis. CA was used by expert and trained speech language therapists (SLT). Due to the correlation between posterior drooling and oropharyngeal dysphagia, two classification systems for eating and drinking ability were used for convergent construct validity calculations: the Functional Oral Intake Scale (FOIS) for children complemented with the Eating and Drinking Ability Classification System (EDACS) in the case of cerebral palsy.
Results:
PPDS had a moderate, negative correlation with the FOIS (Spearman's rho = -0.54, p < 0.001) and a moderate, positive correlation with the EDACS (Spearman's rho = 0.70, p < 0.001). PPDS had an excellent intra-rater (intraclass correlation coefficient = 0.91, p < 0.001) and a good inter-rater reliability (intraclass correlation coefficient = 0.85, p < 0.001). The perfect agreement percentage of the test-retest reliability was high (84%) for the score 0.
Conclusions:
The PPDS is a valid and reliable clinically applicable screening tool for assessing posterior drooling by the SLT. The PPDS enables SLTs to identify posterior drooling more efficiently, non-invasively and reliably in routine clinical settings. Timely recognition of posterior drooling can significantly impact clinical management, particularly by reducing respiratory complications. Performing subsequent PPDS assessments at different times when posterior drooling is suspected is important for the treating paediatrician to determine the underlying cause of posterior drooling. To establish the diagnosis of posterior drooling, the PPDS should not be used as a stand-alone tool but as a bridge between clinical observations and the need for an instrumental assessment.
