Impact and management of drooling in children with neurological disorders: an Italian Delphi consensus.
Cerebral palsy
Delphi
Drooling
Neurological disorders
Pediatrics
Journal
Italian journal of pediatrics
ISSN: 1824-7288
Titre abrégé: Ital J Pediatr
Pays: England
ID NLM: 101510759
Informations de publication
Date de publication:
19 Jul 2022
19 Jul 2022
Historique:
received:
22
11
2021
accepted:
24
06
2022
entrez:
19
7
2022
pubmed:
20
7
2022
medline:
22
7
2022
Statut:
epublish
Résumé
The rate of chronic drooling in children older than 4 years is 0.5%, but it rises to 60% in those with neurological disorders. Physical and psychosocial consequences lead to a reduction in the quality of Life (QoL) of affected patients; however, the problem remains under-recognized and under-treated. We conducted an Italian consensus through a modified Delphi survey to discuss the current treatment paradigm of drooling in pediatric patients with neurological disorders. After reviewing the literature, a board of 10 experts defined some statements to be administered to a multidisciplinary panel through an online encrypted platform. The answers to the questions were based on a 1-5 Likert scale (1 = strongly disagree; 5 = strongly agree). The scores were grouped into 1-2 (disagreement) and 4-5 (agreement), while 3 was discarded. The consensus was reached when the sum of the disagreement or agreement was ≥75%. Fifteen statements covered three main topics, namely clinical manifestations and QoL, quantification of drooling, and treatment strategies. All statements reached consensus (≥75% agreement). The 55 Italian experts agreed that drooling should be assessed in all children with complex needs, having a major impact on the QoL. Attention should be paid to investigating posterior hypersalivation, which is often neglected but may lead to important clinical consequences. Given that the severity of drooling fluctuates over time, its management should be guided by the patients' current needs. Furthermore, the relative lack of validated and universal scales for drooling quantification limits the evaluation of the response to treatment. Finally, the shared therapeutic paradigm is progressive, with conservative treatments preceding the pharmacological ones and reserving surgery only for selected cases. This study demonstrates the pivotal importance of a multidisciplinary approach to the management of drooling. National experts agree that progressive treatment can reduce the incidence of complications, improve the QoL of patients and caregivers, and save healthcare resources. Finally, this study highlights how the therapeutic strategy should be reconsidered over time according to the available drugs on the market, the progression of symptoms, and the patients' needs.
Sections du résumé
BACKGROUND
BACKGROUND
The rate of chronic drooling in children older than 4 years is 0.5%, but it rises to 60% in those with neurological disorders. Physical and psychosocial consequences lead to a reduction in the quality of Life (QoL) of affected patients; however, the problem remains under-recognized and under-treated. We conducted an Italian consensus through a modified Delphi survey to discuss the current treatment paradigm of drooling in pediatric patients with neurological disorders.
METHODS
METHODS
After reviewing the literature, a board of 10 experts defined some statements to be administered to a multidisciplinary panel through an online encrypted platform. The answers to the questions were based on a 1-5 Likert scale (1 = strongly disagree; 5 = strongly agree). The scores were grouped into 1-2 (disagreement) and 4-5 (agreement), while 3 was discarded. The consensus was reached when the sum of the disagreement or agreement was ≥75%.
RESULTS
RESULTS
Fifteen statements covered three main topics, namely clinical manifestations and QoL, quantification of drooling, and treatment strategies. All statements reached consensus (≥75% agreement). The 55 Italian experts agreed that drooling should be assessed in all children with complex needs, having a major impact on the QoL. Attention should be paid to investigating posterior hypersalivation, which is often neglected but may lead to important clinical consequences. Given that the severity of drooling fluctuates over time, its management should be guided by the patients' current needs. Furthermore, the relative lack of validated and universal scales for drooling quantification limits the evaluation of the response to treatment. Finally, the shared therapeutic paradigm is progressive, with conservative treatments preceding the pharmacological ones and reserving surgery only for selected cases.
CONCLUSION
CONCLUSIONS
This study demonstrates the pivotal importance of a multidisciplinary approach to the management of drooling. National experts agree that progressive treatment can reduce the incidence of complications, improve the QoL of patients and caregivers, and save healthcare resources. Finally, this study highlights how the therapeutic strategy should be reconsidered over time according to the available drugs on the market, the progression of symptoms, and the patients' needs.
Identifiants
pubmed: 35854335
doi: 10.1186/s13052-022-01312-8
pii: 10.1186/s13052-022-01312-8
pmc: PMC9297577
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
118Investigateurs
Maria Francesca Aiello
(MF)
Irene Bagnasco
(I)
Pier Antonio Battistella
(PA)
Stefania Bergamoni
(S)
Benedetta Boldrini
(B)
Pasquale Bratta
(P)
Andrea Brusaferro
(A)
Mario Brusco
(M)
Beatrice Burchiani
(B)
Elisa Burdino
(E)
Beatrice Cardinali
(B)
Morena Cassani
(M)
Elena Cavalli
(E)
Anna Cavallini
(A)
Maria Cordelli Duccio
(MC)
Gaetano D'agata
(G)
Giovanna Di Corcia
(G)
Gianluca D'onofrio
(G)
Giulia Fagiolari
(G)
Antonella Fattorusso
(A)
Matteo Felicioni
(M)
Federica Gaiotti
(F)
Cristina Galati
(C)
Luisa Gasola
(L)
Giuseppina Giaquinto
(G)
Chiara Gizzi
(C)
Domenico Leonardo Grasso
(DL)
Chiara Isidori
(C)
Maria Teresa Marcucci
(MT)
Valentina Mazzoni
(V)
Elisabetta Mencaroni
(E)
Gianluca Monacelli
(G)
Francesco Nicita
(F)
Alessandro Orsini
(A)
Annamaria Pellegrino
(A)
Cinzia Peruzzi
(C)
Gianluca Piccolo
(G)
Ilaria Pistola
(I)
Giovanni Prezioso
(G)
Patrizia Pulitano
(P)
Vincenzo Raieli
(V)
Marina Saladino
(M)
Annamaria Sapuppo
(A)
Rossella Sica
(R)
Carlotta Spagnoli
(C)
Maria Tagliente
(M)
Giorgia Tascini
(G)
Gaetano Terrone
(G)
Eleonora Tulli
(E)
Valerio Vinti
(V)
Informations de copyright
© 2022. The Author(s).
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