Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research.
Jana Zang, Saskia Kiehn, Till Flügel and 5 others
PMID 35430715WHAT IT FOUND
Pediatric FEES protocols lack standardization, with no validated scales used in 21 of 22 studies.
While the procedure appears safe, inconsistent documentation prevents comparing results across studies, so clinicians cannot assume one hospital's protocol matches another's.
Key findings
01No study achieved a good rating for methodological quality; 16 were rated fair and 6 poor.
02Only one of the 22 included studies used a validated scale (the Penetration-Aspiration Scale) to report outcomes.
03Substantial bias is expected due to missing parameters and lack of standardization in how FEES was performed and reported.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
All included studies had methodological weaknesses; none were rated 'good'. Meta-analysis was impossible due to missing data and heterogeneous outcome parameters. Retrospective studies often had incomplete documentation, leading to high rates of missing data. The review could not determine if gender differences in dysphagia prevalence exist due to inconsistent reporting. Silent aspiration, a critical clinical concern, was reported in only 4 of the 22 studies.
Declared interests
The study was funded by Universitätsklinikum Hamburg-Eppendorf (UKE).
The easy way to misread this
Do not interpret the safety findings (no adverse events in reported studies) as proof that FEES is universally safe or well-tolerated in all children. Complications were not reported in 13 of the 22 studies, and the review notes that many studies did not systematically record why examinations might have been discontinued or incomplete.