Aerodigestive Clinics as Emerging Pediatric Care Model: The First 100 Patients in Israel

Isr Med Assoc J. 2021 Sep;23(9):569-575.

Abstract

Background: Aerodigestive clinics are run by interdisciplinary medical and surgical teams, and provide complex care coordination and combined endoscopies.

Objectives: To describe the design and patient population of the first pediatric aerodigestive center in Israel.

Methods: A retrospective single-center cohort study was conducted describing patients followed in the aerodigestive clinic of Schneider Children's Medical Center of Israel, a tertiary pediatric hospital, between its inception in January 2017 and June 2020.

Results: During the study period, 100 patients were seen at the combined respiratory and digestive (NoAM) clinic, with a total of 271 visits. Median age at first assessment was 29.5 months (range 3-216). Fifty-six patients (56%) had esophageal atresia and tracheoesophageal fistula. Thirty-nine patients had an identified genetic disorder, 28 had a primary airway abnormality, 28 were oxygen dependent, and 21 were born premature. Fifty-two patients underwent triple endoscopy, consisting of flexible bronchoscopy, rigid bronchoscopy, and gastroscopy. In 33 patients, esophageal dilatation was necessary. Six patients underwent posterior tracheopexy at a median of 6 months of age (range 5 days to 8 years) all with ensuing symptom improvement. The total mean parental satisfaction score on a Likert-type scale of 1-5 (5 = highest satisfaction) was 4.5.

Conclusions: A coordinated approach is required to provide effective care to the growing population of children with aerodigestive disorders. The cross fertilization between multiple disciplines offers a unique opportunity to develop high quality and innovative care. Outcome measures must be defined to objectively measure clinical benefit.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Digestive System Diseases / physiopathology
  • Digestive System Diseases / therapy*
  • Endoscopy / methods*
  • Hospitals, Pediatric / organization & administration
  • Humans
  • Infant
  • Israel
  • Parents / psychology
  • Patient Care / methods*
  • Patient Care / standards
  • Patient Care Team / organization & administration*
  • Patient Care Team / standards
  • Patient Satisfaction
  • Quality of Health Care
  • Respiratory Tract Diseases / physiopathology
  • Respiratory Tract Diseases / therapy*
  • Retrospective Studies
  • Tertiary Care Centers / organization & administration