September 2021 S Butterworth K Fitzsimons J Medina SA Deacon H Wahedally J van der Meulen CJH Russell A multitude of factors are thought to influence speech outcome in patients born with a cleft palate lip ID: 1043037
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1. Comparing Apples And Pears – Identifying And Quantifying Differences In Speech Outcomes For Different Cleft TypesSeptember 2021S Butterworth / K Fitzsimons / J Medina / SA Deacon/ H Wahedally / J van der Meulen/ CJH Russell
2. A multitude of factors are thought to influence speech outcome in patients born with a cleft palate +/- lip. Interventional factorsNon-interventional factors (patient characteristics) Understanding which non-interventional factors influence speech outcome has the potential to allow us to risk adjust outcome dataBackground
3. To investigate the relationship between patient characteristics and speech outcome for children born with a cleft palate +/- lip at 5 years of age.Study aim
4. CRANE-consented children, born with cleft palate +/- lip between 2006 and 2014Cleft type - three groups based on recorded LAHSHAL classification - CPO, UCLP and BCLP Extent of hard palate involvement recordedPresence or absence of Robin Sequence recordedChildren included if all 16 CAPS-A speech parameters recorded at aged 5 CAPS-A scores were used to assess achievement of the 3 UK National Cleft Lip and Palate Speech Audit Outcome StandardsPearson Chi squared tests to assess variations in proportions across non-ordered groupsLogistic regression analysis was used to determine the odds of meeting each cleft speech standard according to sex, cleft type, extent of hard palate involvement and Robin Sequence Methods
5. Speech Outcome Standard Definition of requirement to reach Speech Outcome Standard Interpretation of Speech Outcome Standard 1Green (dark and light) colour code outcome profile on all 16 speech parameters in CAPS-A by 5 years of age Standard 1 is regarded as the benchmark standard for normal speech outcome in a child with a cleft palate2aGreen (dark and light) colour code outcome profile on resonance, nasal airflow and passive CSC categories of CAPS-A and no revisional speech surgery or fistula surgery by 5 years of age Standard 2a relates to the anatomical structure of the velum and is therefore linked to the outcome following palate surgery 3Green (dark and light) colour code outcome profile on Anterior, Posterior and Non-oral CSCs categories of CAPS-A by 5 years of age Standard 3 relates to distinctive articulation errors associated with a cleft palate Speech Standards
6. ExclusionsTotal = 3710Exclude:208 excluded due to syndromic diagnosis 9 patients excluded as sex not recorded22 patients excluded as LAHSHAL code for cleft type classification was missing 26 patients excluded as submucous cleft palateThose with a speech assessment before age 5 (n=69), after age 6 (n=113) or missing an assessment date (n=64) were also excludedCPO =1642N = 31991754 M : 1445 FUCLP = 1092BCLP = 465
7. Speech outcome by sexFemaleMaleP valueOR (95%CI)Speech standard 166.5%54.8%<0.0010.767 (0.657 to 0.896)Speech standard 2a71.2%70.6%0.6971.074 (0.915 to 1.262)Speech standard 374.2%62.5%<0.0010.766 (0.650 to 0.904)
8. Cleft TypeS1OR (95% CI)CP71.6%RefUCLP53.6%0.694 (0.561 – 0.858)BCLP34.6%0.334 (0.256 – 0.435)P value<0.001S2OR (95% CI)74.7%Ref68.3%1.015 (0.811 – 1.271)63.2%0.831 (0.634 – 1.089)<0.001S3OR (95% CI)80.1%Ref61.8%0.612 (0.487 – 0.770)38.3%0.246 (0.187 – 0.323)<0.001
9. In full cohort20% - cleft involving the soft palate21% - cleft involving the soft palate and incomplete hard palate 59% - complete cleft involving the hard and soft palateCleft ExtentNo HP involvementIncomplete HPComplete HPP valueStandard 1495475952<0.001Standard 2a5115031253<0.001Standard 35405351094<0.001
10. Strengths and LimitationsLarge numbersAll centres participate across England, Northern Ireland and Wales.High CRANE consent rateStandardised measures of data collection Assumption of equity in surgical technique and timing Under-reporting of additional conditions compared to HES
11. Sex, Cleft type and Cleft extent are all factors that have a significant impact on speech at 5 years of age. Next stage – Risk adjustment modelIt is hoped that risk stratification will become part of CRANE’s annual report in the future. Conclusions
12. This work was funded by the National Specialised Commissioning Group for England, Welsh Health Specialised Services Committee and NHS Northern IrelandThank yousbutterworth@rcseng.ac.uk