Pediatric Eating Assessment Tool-10 as an indicator to predict aspiration in children with esophageal atresia ☆ Tutku Soyer a, ⁎, Sule Yalcin a , Selen Serel Arslan b , Numan Demir b , Feridun Cahit Tanyel a a Hacettepe University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey b Hacettepe University Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey. abstract article info Article history: Received 16 December 2016 Received in revised form 20 January 2017 Accepted 20 February 2017 Available online xxxx Key words: Esophageal atresia Pediatric Eating Assessment Tool-10 Aspiration Respiratory problems Deglutition Aim: Airway aspiration is a common problem in children with esophageal atresia (EA). Pediatric Eating Assessment Tool-10 (pEAT-10) is a self-administered questionnaire to evaluate dysphagia symptoms in children. A prospective study was performed to evaluate the validity of pEAT-10 to predict aspiration in children with EA. Methods: Patients with EA were evaluated for age, sex, type of atresia, presence of associated anomalies, type of esophageal repair, time of definitive treatment, and the beginning of oral feeding. Penetration-aspiration score (PAS) was evaluated with videofluoroscopy (VFS) and parents were surveyed for pEAT-10, dysphagia score (DS) and functional oral intake scale (FOIS). PAS scores greater than 7 were considered as risk of aspiration. EAT-10 values greater than 3 were assessed as abnormal. Higher DS scores shows dysphagia whereas higher FOIS shows better feeding abilities. Results: Forty patients were included. Children with PAS greater than 7 were assessed as PAS + group, and scores less than 7 were constituted as PAS - group. Demographic features and results of surgical treatments showed no difference between groups (p N 0.05). The median values of PAS, pEAT-10 and DS scores were significantly higher in PAS+ group when compared to PAS- group (p b 0.05). The sensitivity and specificity of pEAT-10 to predict aspiration were 88% and 77%, and the positive and negative predictive values were 22% and 11%, respectively. Type-C cases had better pEAT-10 and FOIS scores with respect to type-A cases, and both scores were statistically more reliable in primary repair than delayed repair (p b 0.05). Among the postoperative complications, only leakage had impact on DS, pEAT-10, PAS and FOIS scores (p b 0.05). Conclusions: The pEAT-10 is a valid, simple and reliable tool to predict aspiration in children. Patients with higher pEAT-10 scores should undergo detailed evaluation of deglutitive functions and assessment of risks of aspiration to improve safer feeding strategies. Level of evidence: Level II (Development of diagnostic criteria in a consecutive series of patients and a universally applied “gold standard”). © 2017 Elsevier Inc. All rights reserved. Respiratory problems are common in patients with repaired esoph- ageal atresia (EA). Nearly half of the patients have respiratory complica- tions [1]. In one study, it was reported that 19% of patients had recurrent pneumonia, 10% had aspiration and 13% had chocking, gagging or cya- nosis during feeding [1]. These complications are due to the gastro- esophageal reflux disease (GERD) in 74% of cases, tracheomalacia in 13%, recurrent tracheoesophageal fistula (TEF) in 13%, and esophageal stricture in 10% of the cases [1]. The incidence of airway aspiration was 37% in patients with EA in videofleuroscopic (VFS) evaluation [2]. It is suggested that dyscoordination of upper esophageal sphincter re- laxation and pharyngeal contraction may result in airway aspiration and most of the respiratory problems are related to aspiration. We pre- viously reported that patients with oropharyngeal dysphagia had higher incidence of airway aspiration and showed severe respiratory problems [3]. Barium swallowing studies and VFS can be used to evaluate the as- piration during deglutition. In addition, manometry and bronchoscopy are commonly used to evaluate aspiration in children with respiratory complications after the repair of EA [3]. However, there is no simple method to assess the risk of aspiration in children with EA. The Eating Assessment Tool-10 (EAT-10) is a validated, self- administered, commonly used tool in clinical practice, which serves for the assessment of symptom-specific outcomes [4]. Serial application of the EAT-10 was shown to be effective in documenting the severity of initial symptoms, monitoring of the treatment efficacy and in prediction of aspiration and the risk of aspiration in patients with dysphagia. Pa- tients with EAT-10 scores higher than 10 had 2.2 times more risk of as- piration and the scores higher than 3 were predictive for airway aspiration [4,5]. Journal of Pediatric Surgery xxx (2017) xxx–xxx ☆ Cross-sectional study. ⁎ Corresponding author at: Hacettepe University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey. Tel.: +90 532 6651960. E-mail address: soyer.tutku@gmail.com (T. Soyer). http://dx.doi.org/10.1016/j.jpedsurg.2017.02.018 0022-3468/© 2017 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Soyer T, et al, Pediatric Eating Assessment Tool-10 as an indicator to predict aspiration in childrenwith esophageal atresia, J Pediatr Surg (2017), http://dx.doi.org/10.1016/j.jpedsurg.2017.02.018