Identifying Paediatric Populations with Increased Risk for Oropharyngeal Dysphagia in Acute and Critical Care Settings: A Scoping Review.

Abstract

Dysphagia is common in hospitalised children. Clarity regarding its prevalence is required to direct service needs. This review reports oropharyngeal dysphagia prevalence in children admitted to acute and/or critical care, following acute illness, medical or surgical intervention. It also explores patient characteristics significantly associated with oropharyngeal dysphagia in these settings. Five electronic databases (EMBASE, CINAHL, Cochrane, PubMed, Scopus) were searched. Studies identified for inclusion involved children (0-16 years), in acute or critical care settings, where prevalence data for new-onset or worsening oropharyngeal dysphagia was reported. Peer reviewed journal articles, including systematic reviews were included. Data was extracted and synthesised using a purpose designed extraction tool. A total of 7,522 studies were screened and 67 studies met criteria. The most researched populations included congenital heart disease surgeries, posterior fossa tumour resections, stroke and post-extubation dysphagia. Populations with the highest documented dysphagia prevalence were children after posterior fossa tumour resection with a new tracheostomy, children using nasal continuous positive airway pressure, and children following ischemic stroke. Characteristics significantly associated with oropharyngeal dysphagia were younger age, lower weight, longer intubation, upper/middle airway dysfunction (e.g., vocal paresis), and presence of additional comorbidities. This review presents synthesised prevalence data for children in acute and critical care settings with new-onset or worsening oropharyngeal dysphagia. It highlights the broad nature of oropharyngeal dysphagia in hospitalised children and the need for more rigorous research into characteristics associated with increased risk to better support screening and early identification of oropharyngeal dysphagia in these settings.