Aerodigestive Complexity Score

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HM Horita et al. J Pediatr 2023; 261: 113549. Open Access! Development of a Medical Complexity Score for Pediatric Aerodigestive Patients

Methods: The authors in this study developed a 7-point medical complexity score .  One point was assigned for each comorbid diagnosis in the following categories: airway anomaly, neurologic, cardiac, respiratory, gastrointestinal, genetic diagnoses, and prematurity. A retrospective chart review was conducted of patients (n=234) seen in the aerodigestive clinic who had ≥2 visits between 2017 and 2021. 

Improvements were followed in the Functional Oral Intake Scale (FOIS)–assigned by aerodigestive feeding therapists.6 The FOIS scale is as follows:

  • •1 = Nothing by mouth
  • •2 = Tube-dependent with minimal attempts of food or liquids (<10%)
  • •3 = Tube-dependent with consistent oral intake of food or liquids
  • •4 = Total oral diet of a single consistency
  • •5 = Total oral diet with multiple consistencies, but requiring special preparations or compensations
  • •6 = Total oral diet with multiple consistencies without special preparation, but with specific food limitations
  • •7 = Total oral diet with no restriction, or <12 months of age on age-appropriate diet

Key findings:

  • At presentation, 69.5% were not at unrestricted age-appropriate diet; 22.7% of the cohort (n = 53) were completely tube dependent
  • There were 165 patients who were not at unrestricted total age-appropriate oral diet at presentation, and the majority (54% [n = 90]) showed improvement in their FOIS scores after aerodigestive team intervention.
  • “For each 1-unit increase in complexity score, there was a 33% decrease in the odds of improvement in FOIS scores (OR, 0.66; 95% CI, 0.51-0.84; P = .001);” however, only neurological comorbidity (OR, 0.26; 95% CI, 0.13-0.53; P < .001) and airway anomaly (OR, 0.35; 95% CI, 0.15-0.79; P = .01) were significantly associated with decreased likelihood to progress in feeding based on FOIS scores
  • Of the 125 patients who were tube fed at initial presentation, 20% (n = 25) were able to achieve full oral feeding after intervention

My take: While the complexity score did correlate with likelihood of progressing with oral feedings, it appears that this score is unnecessary as likelihood of progressing is mainly related to two factors: neurological comorbidities and airway anomalies.

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