The eating and drinking classification system (EDACS) for cerebral palsy: reliability and stability over time

Eating and Drinking Ability Classification System (EDACS) describes the full range of eating and drinking abilities of people with cerebral palsy (CP) in 5 distinct levels, using key features of safety and efficiency. This study investigated the stability of EDACS using retrospective case‐record data. Patients and method: Case‐records for 100 children with CP were examined to collect retrospective data about eating and drinking abilities, at four time‐points, minimum 2years between each time‐point. Gender, GMFCS level, presence of feeding tube and orthopaedic issues were also recorded. One speech and language therapist (SLT) classified eating and drinking ability using EDACS for all cases at all time‐points; a second SLT assigned EDACS levels for 25 cases at all time‐points. Stability over time and inter‐observer reliability were assessed using intraclass correlation coefficient (ICC). Association between children's GMFCS and EDACS levels was calculated using Kendall's tau. Results: Out of 100 children, 50 were male, 49 had feeding tubes, and 85 had orthopaedic issues. ICC across all time‐points was 0.97 (95% CI 0.96–0.98); changes in EDACS levels occurred infrequently and never by more than one level. ICC between the two SLTs was 0.95 (95% CI 0.91–0.97). Kendall's tau was 0.58, p<0.001 (GMFCS vs EDACS). Conclusion: Children's eating and drinking abilities classified retrospectively using EDACS appear reliable and stable over 6 or more years. This study provides evidence to support use of EDACS to predict future outcomes. Some parents want to know what the future holds for their children when making decisions about supplementary nutrition including enteral feeding.