Ernesto Fernandez, MD
University of Texas Health Science Center At Houston
Houston, Texas
Disclosure information not submitted.
Vidit Bhargava, MD
Pediatric Intensivist
University of Alabama at Birmingham
Birmingham, Alabama, United States
Disclosure information not submitted.
Erika Mendoza, MD
Pediatric Intensivist
University of Alabama at Birmingham
Birmingham, Alabama, United States
Disclosure information not submitted.
Michelle Ramirez, MD
Hassenfeld Children's Hospital at NYU Langone
Brooklyn, NY
Disclosure information not submitted.
Sarah Ginsburg, MD
Assistant Professor
UT Southwestern Medical Center, United States
Disclosure information not submitted.
Erik Su, MD
Assistant Professor
Baylor College of Medicine at Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Title: Laryngeal ultrasound evaluation of vocal fold immobility after pediatric cardiac surgery
Introduction: True Vocal Fold Immobility (TVFI) is a known complication following cardiac surgery in children/infants. The gold standard for diagnosis of TVFI is laryngoscopy during which children may experience agitation and distress. Recently, the authors published a metanalysis demonstrating 91% sensitivity and 97% specificity of Laryngeal Ultrasound (LUS) compared to laryngoscopy in pediatrics in diagnosing TVFI. We hypothesized that LUS could facilitate timely bedside diagnosis of TVFI after pediatric cardiac surgery. This project was approved as a quality improvement initiative by the authors’ respective IRBs.
Methods: Multicenter prospective LUS examination of all children with symptoms or a high suspicion of TVFI after high-risk cardiac surgery was performed.
Results: 70 patients underwent LUS. The most common indications were asymptomatic with or without high-risk procedure (35%), hoarse cry (20%), stridor (11%), respiratory failure (10%). Findings included symmetric vocal fold movement (77%), TVFI (21%); one patient was excluded for poor image quality (1.4%). ENT examined 29 patients (41%). The overall agreement in diagnosis of TVFI was found to be 86% (25/29); sensitivity of 73% and specificity 94%. Of the 4 patients with discordant assessments, 3 demonstrated normal LUS but had TVFI by laryngoscopy while 1 patient with abnormal LUS was normal per laryngoscopy. 62% of the time, LUS was performed prior to ENT evaluation, and 28% occurred on the same day. Median time from extubation to LUS 2.0 days (IQR25-75 1.0-4.0) vs 3.0 days (IQR25-75 2.0-5.0) for time to ENT evaluation, p=0.09 (Mann-Whitney U Test).
Conclusions: LUS has a high degree of agreement with ENT laryngoscopy. As asymptomatic patients were less likely to receive laryngoscopy, the true sensitivity and specificity of the test is likely higher than that observed in this study. More patients received LUS studies earlier than ENT studies and this demonstrated a tendency towards significance.