A302 INAPPROPRIATE REFERRALS FOR VIDEO FLUOROSCOPIC SWALLOWING STUDIES; DEFINING THE SCOPE OF THE PROBLEM
| Autor: | W G Paterson, S Canning, s sedore |
|---|---|
| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | Journal of the Canadian Association of Gastroenterology. 1:433-433 |
| ISSN: | 2515-2092 2515-2084 |
| DOI: | 10.1093/jcag/gwy009.302 |
| Popis: | BACKGROUND: The first step in assessment of dysphagia is determining if it is oropharyngeal or esophageal in origin. Over half of patients with esophageal dysphagia will relate the sensation of food sticking to the cervical area. The timing of the dysphagia and associated symptoms are useful in differentiating between oropharyngeal and esophageal dysphagia with proximal referral. Unfortunately, many physicians are unaware that esophageal dysphagia is commonly sensed in the cervical area and this can lead to inappropriate referrals for videofluoroscopic swallowing studies (VFSS) by Speech Language Pathology (SLP). In our institution, a number of patients referred are found to have predominantly esophageal type dysphagia. This has contributed to long wait times for an SLP assessment and a delay in diagnosis of patients with esophageal dysphagia. The full scope of the problem remains unclear. AIMS: To identify the number of patients inappropriately referred for VFSS. METHODS: We have created a database of the VFSS studies performed by the SLP department in 2016. This was used to extract the reports of all VFSS studies and identify the patients who had normal or minimally abnormal oropharyngeal swallowing but significant abnormalities in esophageal transit. The charts of all patients referred between January 1st, 2016 and June 30th, 2016 were reviewed. RESULTS: A total of 165 referrals for VFSS were made between January 1st-June 30th, 2016. Of those, only 110 patients underwent VFSS assessment. The remainder were cancelled or not performed for reasons unavailable in the chart review. Of the 110 patients who underwent VFSS, 12 did not have results available on the electronic medical record. The remaining 98 charts for which the VFSS results were available, were analyzed. Oropharyngeal dysphagia was identified as the etiology in 70% of the patients. In 12% there was comment of mild oropharyngeal impairments with evidence of impaired esophageal transit and in 10% of cases there was normal oropharyngeal but evidence of esophageal dysfunction. 5% of patients had normal oropharyngeal dysphagia with no remarks regarding the presence of esophageal function. These studies resulted in referral to a gastroenterologist in our institution in 9% of cases. It was also noted that 16% of cases with oropharyngeal dysphagia had been previously seen by gastroenterology. CONCLUSIONS: In our institution, up to 22% of patients undergong VFSS assessments appear to have esophageal dysphagia and nearly 10% of these cases resulted in referrals to gastroenterology. This has likely contributed to the long wait times for orophyarneal dysphagia assessment and delayed appropriate assessment of patients with esophageal dysphagia. Based on this data, we plan to develop a tool to help referring physicians determine whether oropharyngeal or esophageal assessment would be most appropriate. FUNDING AGENCIES: None |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|