Assessing Inpatient Rehabilitation Outcomes for Pediatric Dysphagia with the PEDI-EAT-10.

No control group and no randomisation. Every child got usual inpatient therapy, so the improvement cannot be credited to any treatment, and the authors themselves say it may simply reflect typical recovery during inpatient rehabilitation. Only 23 children, from a single hospital, and many fewer for some analyses (12 and 6 children for the PAS correlations at admission and discharge). The children were very mixed: some had new acquired injuries such as stroke or brain injury and some had long-standing congenital conditions, and the time since onset ranged from 13 to 4447 days. The authors say this heterogeneity may bias the estimate of how responsive the measure is, and that results may not transfer to other centres. Follow-up videofluoroscopy was done in only 8 children, because a repeat study was not always clinically indicated. This weakens the correlations with the questionnaire. Change in PEDI-EAT-10 varied widely between children, and some got worse (the individual changes ran from a 40-point improvement to an 8-point worsening), so a group average hides children who did not improve. The adult version of the FOIS was used in children, and the authors note that the comparison measures (FOIS, IDDSI Functional Diet Scale) may themselves have limits in a pediatric population. How much each child's length of stay affected their scores was not fully assessed. The study stopped at discharge, so nothing is known about whether the gains lasted.

The authors state the investigators have no financial or nonfinancial disclosures to make in relation to this project. No funding source is named in the text.

Do not read the fall in PEDI-EAT-10 scores as proof that dysphagia therapy works. There was no control group, and the authors say the change may just reflect typical progress during inpatient rehabilitation; some children's scores got worse. The questionnaire also did not track with aspiration seen on videofluoroscopy, so a good parent score is not a safe swallow.