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Xia X, Zhang W, Guo J, Chang X, Zhao R, Wang J, Pang X, Zhang J. Diagnostic utility of different dysphagia screening tools to detect dysphagia in individuals with amyotrophic lateral sclerosis. Neurol Sci 2023; 44:3919-3927. [PMID: 37368071 DOI: 10.1007/s10072-023-06918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Dysphagia is a common and serious clinical symptom of amyotrophic lateral sclerosis (ALS). The study aimed to evaluate the diagnostic utility of four dysphagia screening tools in ALS, including the ALS Functional Rating Scale-Revised (ALSFRS-R) bulbar subscale, water-swallowing test (WST), Eating Assessment Tool-10 (EAT-10) and Sydney Swallow Questionnaire (SSQ). METHODS A total of 68 individuals from First Hospital, Shanxi medical university, were recruited in the study. The ALSFRS-R, WST, EAT-10, SSQ and the gold standard video fluoroscopic swallowing study (VFSS) were performed. The Penetration Aspiration Scale (PAS) during VFSS was assessed to identify unsafe swallowing (PAS ≥ 3) and aspiration (PAS ≥ 6). Receiver operator characteristic curve (ROC) analyses were performed to evaluate the accuracy of the 4 tools. Youden index was used to determine the ideal cut-off value for each tool. RESULTS Of the patients, 20.59% (14/68) presented unsafety swallowing and 16.18% (11/68) had aspiration. The four tools could effectively identify patients with unsafe swallowing and aspiration. The EAT-10 had the maximum AUC (0.873 and 0.963, respectively) among the tools in the diagnosis of unsafe swallowing and aspiration. To detect unsafe swallowing and aspiration, an EAT-10 score of 6 (sensitivity: 78.6%, specificity: 87.0%) and an EAT-10 score of 8 (sensitivity: 90.9%, specificity: 91.2%), were the most appropriate cut-off points, respectively. CONCLUSIONS The ALSFRS-R bulbar subscale, WST, EAT-10, and SSQ could effectively identify unsafe swallowing and aspiration in patients with ALS. Of the four tools, the EAT-10 was relatively accurate, safe, and convenient. Further studies including more patients should be conducted to verify the conclusions.
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Affiliation(s)
- Xiaoqian Xia
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China.
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Rongjuan Zhao
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Jing Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
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Zhang H, Zhang S, Ye C, Li S, Xue W, Su J, Qiu Y, Zhao L, Fu P, Jiang H, He X, Deng S, Zhou T, Zhou Q, Tang M, Chen K. Cross-sectional study on dysphagia evaluation in community-dwelling older adults using the Eating Assessment Tool (EAT) -10, EAT-2, and Water Swallow Test. Geriatr Nurs 2023; 54:258-263. [PMID: 37897931 DOI: 10.1016/j.gerinurse.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Dysphagia is a health concern that causes severe complications and affects the life quality of the older population. This study aimed to determine the diagnostic performance of the Eating Assessment Tool (EAT)-2 compared with the EAT-10 and the Water Swallow Test (WST) in screening for dysphagia. METHODS A cross-sectional study was conducted among 5,090 community-dwelling older adults. Dysphagia was evaluated using both a subjective measure, the 10-item EAT (EAT-10) and an objective measure, the WST. The kappa index in pairs were analyzed. The validity and reliability of EAT-2 were also assessed. RESULTS The sensitivity and specificity of the EAT-2 were 96.3 % and 94.8 %, respectively. The kappa index between the EAT-2 and EAT-10 was 0.64, whereas it was 0.11 between the EAT-10 and WST. CONCLUSIONS The EAT-2 was a simpler screening tool for dysphagia. Combining the subjective questionnaire (EAT-10 or EAT-2) and the objective test (WST) is recommended.
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Affiliation(s)
- Huafang Zhang
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Simei Zhang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Chenxi Ye
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Sihan Li
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Wenfeng Xue
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Jie Su
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Yufeng Qiu
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Lancai Zhao
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Pingping Fu
- Department of Rehabilitation Medicine, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Haiyan Jiang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaona He
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Shunfeng Deng
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Tao Zhou
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Qi Zhou
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
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Chao W, You-Qin M, Hong C, Hai-Ying Z, Su-Xue J, Lan X, Zhong W. Effect of Capsaicin Atomization on Cough and Swallowing Function in Patients With Hemorrhagic Stroke: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:503-512. [PMID: 36716393 DOI: 10.1044/2022_jslhr-22-00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients with hemorrhagic stroke have high mortality and disability rates. Nevertheless, early rehabilitation interventions can improve their outcomes. We aimed to apply capsaicin atomization as early intervention to patients with hemorrhagic stroke and explore improvements in cough and swallowing functions. METHOD Patients with hemorrhagic stroke were randomly divided into the control group, which received routine care, and the intervention group, which underwent the capsaicin solution nebulization scheme in addition to routine care. Differences in the presence/absence of cough reflex and number of coughs in response to capsaicin, the presence/absence of swallowing reflex in response to water, the presence/absence of postswallow residue, substance P (SP) concentration, and pulmonary inflammation between the two groups were determined before and after the intervention. RESULTS A total of 53 patients with hemorrhagic stroke were included. Results showed no statistically significant difference in cough reflex in both groups after the intervention (p > .05). The degree of cough in the intervention group was stronger than that in the control group (p = .046). No statistically significant difference was observed in the number of patients with swallowing reflex in response to water between the groups (p > .05). The presence/absence of postswallow residue of the intervention group was stronger than that of the control group (p = .032). No statistically significant difference was observed between the Glasgow Coma Scale scores of the groups after the intervention (p > .05). SP in the intervention group was significantly increased (p = .031). The Clinical Pulmonary Infection Score was significantly lower in the control group, and the difference was statistically significant (p = .028). CONCLUSIONS Capsaicin nebulization can help enhance the number of coughs in response to capsaicin, reduce postswallow residue, and increase the level of SP in patients with hemorrhagic stroke and has a positive effect on pulmonary inflammation. This study provides intervention points for cough and swallowing rehabilitation after a hemorrhagic stroke. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21956903.
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Affiliation(s)
- Wu Chao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mao You-Qin
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Hong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhang Hai-Ying
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Su-Xue
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Lan
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wang Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2023; 38:76-121. [PMID: 35639156 PMCID: PMC9873728 DOI: 10.1007/s00455-022-10465-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is prevalent in the elderly and persons with complex medical conditions, resulting in considerable medical and psychosocial consequences and reduced quality of life. Many prevalence studies regard OD in relation to age or diagnosis. Knowledge on the prevalence of OD in different healthcare settings is lacking. This systematic review aimed to estimate the prevalence of OD in adults admitted to hospitals, rehabilitation facilities, nursing homes, and palliative care facilities through meta-analyses. A systematic literature search was completed including all dates up to March 30, 2021. The methodology and reporting were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Forty-four out of 1,956 screened articles were deemed eligible. Considerable heterogeneity in definitions of OD and type and quality of selected outcome measures were observed. Overall within-group pooled prevalence estimates for OD determined by meta-analysis were 36.5% (95% CI 29.9 - 43.6) in the hospital setting, 42.5% (95% CI 35.8 - 49.5) in the rehabilitation setting, and 50.2% (95% CI 33.3-67.2) in nursing homes. No OD prevalence data were identified for palliative care facilities. Results for between-group analyses of OD prevalence estimates in the hospital setting were non-significant for type of assessment method, diagnostic group, and type of hospital ward, but indicated significantly higher prevalence estimates in nursing homes when using screening compared to patient-report. Future research should provide OD prevalence data for palliative care, achieve consensus in OD-related terminology when performing prevalence studies, and use screening and assessments with optimal diagnostic performance and psychometric properties.
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Affiliation(s)
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Speech Pathology, Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- REMEO Stockholm, Stockholm, Sweden
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Tabaoka H. [Relationship between aspiration pneumonia and oral health assessment tool (OHAT)]. Nihon Ronen Igakkai Zasshi 2023; 60:400-405. [PMID: 38171757 DOI: 10.3143/geriatrics.60.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
AIM This study clarified the relationship between aspiration pneumonia and the oral health status. METHODS A total of 809 users from Kounankai were targeted. The Oral Health Assessment Tool (OHAT) includes eight items: lip, tongue, gingiva/mucosa, saliva, remaining teeth, dentures, oral cleaning, and toothache. Information on aspiration pneumonia was collected from each facility. A binomial logistic regression analysis was performed, with aspiration pneumonia as the objective variable and the OHAT items as explanatory variables. The analysis was performed using the R software program, version 4.0. 2, with a significance level of < 5%. RESULTS No significant association was found between the development of aspiration pneumonia and the OHAT score. The proportion of males was significantly higher in the aspiration pneumonia group than in the group without pneumonia. CONCLUSION No association was found between the development of aspiration pneumonia and the OHAT score.
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Teramoto S. The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia. Respir Investig 2021; 60:45-55. [PMID: 34782300 DOI: 10.1016/j.resinv.2021.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/02/2023]
Abstract
In the 21st century, aspiration pneumonia (ASP) is very common in older patients, and has a high mortality rate. ASP is diagnosed following confirmation of inflammatory findings in the lungs and overt aspiration or the existence of dysphagia. It is dominant in hospitalized community-acquired pneumonia (CAP), nursing and healthcare-associated pneumonia (NHCAP), and hospital-acquired pneumonia (HAP). The incidence of ASP is increasing every year. The human and experimental animal data revealed that micro-aspiration due to dysphagia during the night is the central mechanism of ASP. Therefore, the precise assessment of swallowing function is the key to diagnose ASP. From a therapeutic point of view, an appropriate administration of antibiotics, as well as a comprehensive approach for dysphagia plays a pivotal role in the prognosis and recovery from ASP. The non-pharmacologic approach, including swallowing rehabilitation and oral care, and a pharmacologic approach including ACE inhibitors and bronchodilators, are essential modalities for treatment and prevention of ASP. The clinical data of NHCAP provides us with a promising treatment strategy for ASP.
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Affiliation(s)
- Shinji Teramoto
- Department of Respiratory Medicine, Tokyo Medical University Hachioji Medical Center, Japan.
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Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, Alexandrov A, Watkins CL. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database Syst Rev 2021; 10:CD012679. [PMID: 34661279 PMCID: PMC8521523 DOI: 10.1002/14651858.cd012679.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties. OBJECTIVES Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy. SELECTION CRITERIA We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital. DATA COLLECTION AND ANALYSIS Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests. MAIN RESULTS Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests. AUTHORS' CONCLUSIONS We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.
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Affiliation(s)
- Elizabeth Boaden
- Faculty of Health and Care , University of Central Lancashire , Preston, UK
| | - Jane Burnell
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Lucy Hives
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Andrew Clegg
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Mary W Lyons
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Hazel Roddam
- Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Anne Alexandrov
- University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Omura T, Matsuyama M, Nishioka S, Sagawa S, Seto M, Naoe M. Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days. Arch Phys Med Rehabil 2021; 102:2165-2171. [PMID: 34252394 DOI: 10.1016/j.apmr.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DESIGN The study design was a prospective cohort study. Participants were followed for 60 days from admission. SETTING LTC wards. PARTICIPANTS Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. RESULTS The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. CONCLUSIONS Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.
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Affiliation(s)
- Tomoya Omura
- Department of Oral Health Care and Rehabilitation, Doctor's Course of Oral Health Science Graduate School of Oral Sciences, Tokushima University, Tokushima; Department of Rehabilitation, Naruto-Yamakami Hospital, Tokushima.
| | - Miwa Matsuyama
- Department of Oral Health Care and Rehabilitation, Institute of Health Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shota Nishioka
- Department of Rehabilitation, Naruto-Yamakami Hospital, Tokushima
| | - Shomu Sagawa
- Department of Rehabilitation, Naruto-Yamakami Hospital, Tokushima
| | - Masaya Seto
- Department of Rehabilitation, Naruto-Yamakami Hospital, Tokushima
| | - Mitsugu Naoe
- Department of Rehabilitation, Naruto-Yamakami Hospital, Tokushima
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Association between swallowing function and oral bacterial flora in independent community-dwelling elderly. Aging Clin Exp Res 2021; 33:157-163. [PMID: 32152814 DOI: 10.1007/s40520-020-01521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Increasing incidences of swallowing dysfunction, or dysphagia, a risk factor for aspiration pneumonia, are being reported in aging populations. AIMS To investigate the relationship between swallowing function and oral bacteria in independent, community-dwelling elderly. METHODS This study recruited 139 community-dwelling individuals aged ≥ 70 years with poor swallowing function. The presence of anaerobic (Prevotella spp. and Fusobacterium spp.) and aerobic bacteria was examined in the participants' oral cavity flora. Swallowing function was evaluated using a 30 mL water swallowing test. Multivariate logistic regression analyses were performed to examine the association between oral bacteria and swallowing function. RESULTS Swallowing function was assessed as abnormal in 2.9% and as abnormal in 47.5% of the subjects. The colony-forming units (CFUs/ml) of Prevotella spp. were associated with the swallowing dysfunction (odds ratio [OR] 3.45, 95% confidence interval [CI] 1.49-8.11). Further, CFUs/ml of Fusobacterium spp. and aerobes did not correlate with the swallowing dysfunction but were related with the number of teeth (OR 2.71; 95% CI 1.28-5.74, and OR 0.40; 95% CI, 0.18-0.91, respectively) CONCLUSIONS: Swallowing dysfunction in community-dwelling elderly is associated with increased abundance of Prevotella spp., which indirectly may be an increased risk factor for aspiration pneumonia.
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Chen LY, Weng WB, Wang W, Chen JF. Analyses of High-Risk Factors for Cervical Lymph Node Metastasis in Laryngeal Squamous Cell Carcinoma and Establishment of Nomogram Prediction Model. EAR, NOSE & THROAT JOURNAL 2020; 100:657S-662S. [PMID: 32041419 DOI: 10.1177/0145561320901613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Laryngeal squamous cell carcinoma (LSCC) is one of the most common laryngeal tumors, and its incidence is increasing yearly; however, whether lymph node dissection should be performed during surgery remains unclear. We retrospectively analyzed the clinical and pathological data of 246 cases of LSCC and developed a nomogram for the prediction of lymph node metastasis (LNM) of LSCC. The predictive performance and consistency of the model were evaluated using the consistency coefficient (C-index) and calibration curve, respectively. Among 246 cases of LSCC, 52 cases had metastasis with a positivity rate of 21.14%. Multivariate analyses showed that dysphagia, clinical T stage, and pathological differentiation were independent risk factors for LNM in LSCC. The accuracy of the contour map used to predict the risk for LNM was 0.809. Overall, this nomogram model can be used to evaluate LNM in patients with LSCC before surgery to decide whether to conduct neck dissection and improve patient prognosis.
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Affiliation(s)
- Lu-Ying Chen
- Department of Otorhinolaryngology Head and Neck Surgery, 89657the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-Bin Weng
- Department of Otorhinolaryngology Head and Neck Surgery, 89657the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wen Wang
- Department of Otorhinolaryngology Head and Neck Surgery, 89657the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian-Fu Chen
- Department of Otorhinolaryngology Head and Neck Surgery, 89657the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Teramoto S, Komiya K. Predictive Roles of the Repetitive Saliva Swallowing Test (RSST) in Aspiration Pneumonia and Other Respiratory Diseases: Does the RSST Have a Predictive Role in Aspiration Pneumonia and Other Respiratory Diseases? RESPIRATORY DISEASE SERIES: DIAGNOSTIC TOOLS AND DISEASE MANAGEMENTS 2020. [PMCID: PMC7298539 DOI: 10.1007/978-981-15-4506-1_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patients with dysphagia do not always present with subjective symptoms. However, asymptomatic dysphagia can also cause clinical issues, especially in those with respiratory conditions. Therefore, adequate screening is an essential beginning to their care. The repetitive saliva swallowing test (RSST) is one of the safest screening methods for dysphagia; it can be easily performed by nonprofessionals in any setting. There is evidence of its predictive values in aspiration pneumonia, chronic obstructive pulmonary disease (COPD), artificial ventilation, and other conditions. Additionaly, it has recently been found to be a strong predictor of the risk of future COPD exacerbation. The cost-effectiveness, harmlessness, and simplicity make it an optimal screening method for the large population of patients with respiratory conditions, although different cutoff values may be useful in different populations. It also takes into account multiple aspects of the swallowing ability, such as respiration, musculature, cognition, and general well-being.
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Affiliation(s)
- Shinji Teramoto
- Department of Respiratory Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kosaku Komiya
- Respiratory Medicine & Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita Japan
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Labeit B, Muhle P, Ogawa M, Claus I, Marian T, Suntrup-Krueger S, Warnecke T, Schroeder JB, Dziewas R. FEES-based assessment of pharyngeal hypesthesia-Proposal and validation of a new test procedure. Neurogastroenterol Motil 2019; 31:e13690. [PMID: 31381234 DOI: 10.1111/nmo.13690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. METHODS A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. KEY RESULTS The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005). CONCLUSION AND INFERENCES Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Thomas Marian
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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Rodriguez AE, Restrepo MI. New perspectives in aspiration community acquired Pneumonia. Expert Rev Clin Pharmacol 2019; 12:991-1002. [PMID: 31516051 DOI: 10.1080/17512433.2019.1663730] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Aspiration pneumonia is a subclass of community-acquired pneumonia that is expected to have an increasing contribution in mortality and morbidity, particularly in the elderly population over the next coming decades. While studies have revealed significant progress in identifying risk factors for aspiration pneumonia, the clinical presentation and diagnosis remain challenging to healthcare providers. Areas covered: We conducted a broad literature review using the MeSH heading in PubMed/MEDLINE of 'aspiration pneumonia' from January 1970 to July 2019. The understanding of the microbiology of aspiration pneumonia has evolved from a possible shift in the causative organisms away from anaerobes to traditional community-acquired pneumonia organisms. The importance of this shift is not yet known, but it has questioned the pathogenic role of anaerobes, appropriate anaerobic testing and the role of these pathogens in the pulmonary microbiome in patients with pneumonia. The identification of risk factors led to strategies to prevent or minimize the risk of aspiration pneumonia with moderate success. Expert opinion: Our expert opinion is that further research is needed to determine the role of the microbiome with aspiration pneumonia and patient risk factors. There is also a great need to develop clinical tools to help providers diagnose, treat, and prevent aspiration pneumonia.
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Affiliation(s)
- Abraham E Rodriguez
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health , San Antonio , TX , USA.,Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System , San Antonio , TX , USA
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health , San Antonio , TX , USA.,Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System , San Antonio , TX , USA
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Hara K, Tohara H, Minakuchi S. Treatment and evaluation of dysphagia rehabilitation especially on suprahyoid muscles as jaw-opening muscles. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:151-159. [PMID: 30302133 PMCID: PMC6175969 DOI: 10.1016/j.jdsr.2018.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
In our aging society, the number of patients with dysphagia, which is associated with disease and aging, is rapidly increasing. The swallowing reflex is a complex process that involves coordinated contractions of swallowing muscles. Many researchers have reported that age-related changes, such as frailty and sarcopenia, affect swallowing muscles and contribute to the decline in the swallowing function. Thus, simple, non-invasive evaluation methods and exercises for swallowing muscles in elderly patients with dysphagia are important. Anterior–superior hyolaryngeal elevation during swallowing results from contractions of the suprahyoid muscle, which plays a primary role in opening the upper esophageal sphincter, along with relaxation of the cricopharyngeal muscle and laryngeal closure. Thus, many researchers have studied methods for evaluating and augmenting suprahyoid muscles. On the other hand, some researchers have reported on dysphagia rehabilitation focused on jaw-opening actions, because hyolaryngeal elevation muscles correspond with jaw-opening muscles. In this study, we describe a new dysphagia evaluation method and an exercise that focuses on suprahyoid muscles with application of jaw-opening actions.
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Oba S, Tohara H, Nakane A, Tomita M, Minakuchi S, Uematsu H. Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia. Odontology 2016; 105:96-102. [DOI: 10.1007/s10266-016-0238-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/12/2016] [Indexed: 11/24/2022]
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Manabe T, Mizukami K, Akatsu H, Hashizume Y, Teramoto S, Nakamura S, Kudo K, Hizawa N. Prognostic Factors Related to Dementia with Lewy Bodies Complicated with Pneumonia: An Autopsy Study. Intern Med 2016; 55:2771-2776. [PMID: 27725535 PMCID: PMC5088536 DOI: 10.2169/internalmedicine.55.6868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective In patients demonstrating dementia with Lewy bodies (DLB), pneumonia is a common complication. However, the prognostic factors for the survival time in DLB with pneumonia have not been investigated by autopsy in patients with neuropathologically confirmed DLB. Methods We conducted a retrospective study of the medical and autopsy reports of 42 patients admitted to a Japanese hospital between 2005 and 2014. The patients were neuropathologically diagnosed as having DLB by post-mortem examinations. We analyzed the effects of various factors on the time from DLB onset to death. Results Thirty-nine of the 42 patients with DLB (92.9%) developed pneumonia during hospitalization. The median age at DLB onset was 78 years and the median time from DLB onset to death was 8 years. The Cox proportional hazard model demonstrated cerebral infarction [Hazard Ratio (HR), 2.36 (95% CI 1.12-4.96), p=0.023], muscle weakness [HR, 2.04 (0.95-4.39), p=0.067], male sex [HR, 2.84 (1.24-6.50), p=0.014], and age at onset (≥78 years.) [HR, 4.71 (1.82-12.18), p=0.001] to be prognostic factors for a shorter time from DLB onset to death. Conclusion Careful treatment of cerebral infarction and muscle weakness of the lower extremities is crucial for DLB patients with pneumonia, especially for those over 78 years of age, in order to maximize the patients' life expectancies.
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Affiliation(s)
- Toshie Manabe
- Department of Social Health and Stress Management, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
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Lee KM, Kim HJ. Practical Assessment of Dysphagia in Stroke Patients. Ann Rehabil Med 2015; 39:1018-27. [PMID: 26798618 PMCID: PMC4720755 DOI: 10.5535/arm.2015.39.6.1018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/09/2015] [Indexed: 11/05/2022] Open
Abstract
Objective To develop a quantitative and organ-specific practical test for the diagnosis and treatment of dysphagia based on assessment of stroke patients. Methods An initial test composed of 24 items was designed to evaluate the function of the organs involved in swallowing. The grading system of the initial test was based on the analysis of 50 normal adults. The initial test was performed in 52 stroke patients with clinical symptoms of dysphagia. Aspiration was measured via a videofluoroscopic swallowing study (VFSS). The odds ratio was obtained to evaluate the correlation between each item in the initial test and the VFSS. A polychotomous linear logistic model was used to select the final test items. Results Eighteen of 24 initial items were selected as significant for the final tests. These 18 showed high initial validity and reliability. The Spearman correlation coefficient for the total score of the test and functional dysphagia scale was 0.96 (p<0.001), indicating a statistically significant positive correlation. Conclusion This study was carried out to design a quantitative and organ-specific test that assesses the causes of dysphagia in stroke patients; therefore, this test is considered very useful and highly applicable to the diagnosis and treatment of dysphagia.
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Affiliation(s)
- Kyoung Moo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyo Jong Kim
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Shin S, Shutoh N, Tonai M, Ogata N. The Effect of Capsaicin-Containing Food on the Swallowing Response. Dysphagia 2015; 31:146-53. [PMID: 26531834 PMCID: PMC4824833 DOI: 10.1007/s00455-015-9668-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 10/26/2015] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the effect of regular ingestion of capsaicin-containing food that is easily available in everyday life on the latency of the swallowing response (LSR). Pickled Napa cabbage was selected as the food for the present study. One portion (10 g) of pickled Napa cabbage provides 1.5 µg of capsaicin. Participants ingested pickled Napa cabbage (10 g) before every meal for 20 days (days 1-20). LSR was measured pre-intervention (day 0) and post-intervention (day 21). The participants then followed their regular diet, without foods containing red pepper, from day 21 to day 27, and LSR was measured on day 28 (follow-up LSR). Sixteen elderly participants (two male, 14 female; age 81.6 ± 9.39 years) and 10 young participants (all female; age 21.6 ± 0.52 years) participated in the study. The pre-intervention LSR was 2.04 ± 1.60 s in elderly participants and 1.27 ± 0.27 s in young participants. In the elderly group, the post-intervention LSR (day 21) was 1.47 ± 1.05 the follow-up LSR (day 28) was 1.99 ± 1.80 s (p = 0.044 and 0.502, respectively, compared to pre-intervention). In the young group, the post-intervention and follow-up LSR values were 1.07 ± 0.20 s and 1.04 ± 0.10 s, respectively (p = 0.016 and 0.038, respectively, compared to pre-intervention). Swallowing function was improved by pickled Napa cabbage containing capsaicin, but capsaicin supplementation may need to be maintained to have an ongoing effect.
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Affiliation(s)
- Satoko Shin
- Department of Basic Nursing Sciences, Oita University of Nursing and Health Sciences, 2944-9 Megusuno, Oita, Oita Prefecture, 870-1201, Japan.
| | - Nobumichi Shutoh
- Graduate School of Maritime Sciences, Kobe University, 5-1-1, Fukae-minamimachi, Higashinada-Ku, Kobe, Hyogo Prefecture, 658-0022, Japan
| | - Miho Tonai
- Department of Basic Nursing Sciences, Oita University of Nursing and Health Sciences, 2944-9 Megusuno, Oita, Oita Prefecture, 870-1201, Japan
| | - Naoko Ogata
- Mimihana Clinic, 62 Kuchido, Oita, Oita Prefecture, 870-1162, Japan
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Abstract
Backgrounds Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly. Methodology and Principal Findings We conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76%) who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL), and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample) were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16–22.62, p < 0.001), daily oxygen therapy (OR = 8.29, 95% CI: 4.39–15.65), feeding support dependency (OR = 8.10, 95% CI: 6.27–10.48, p < 0.001), and urinary catheterization (OR = 4.08, 95% CI: 2.81–5.91, p < 0.001). In the multiple logistic regression analysis, the risk factors associated with aspiration pneumonia after propensity-adjustment (258 subjects each) were sputum suctioning (OR = 3.276, 95% CI: 1.910–5.619), deterioration of swallowing function in the past 3 months (OR = 3.584, 95% CI: 1.948–6.952), dehydration (OR = 8.019, 95% CI: 2.720–23.643), and dementia (OR = 1.618, 95% CI: 1.031–2.539). Conclusion The risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing repetitive aspiration pneumonia.
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Tejima C, Kikutani T, Takahashi N, Tamura F, Yoshida M. Application of simple swallowing provocation test with fiberoptic endoscopic evaluation of swallowing in a cross-sectional study. BMC Geriatr 2015; 15:48. [PMID: 25885208 PMCID: PMC4407463 DOI: 10.1186/s12877-015-0049-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to develop a simultaneously swallowing provocation test for dysphagia patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES), as well as to evaluate its efficacy. Methods In this test, 0·4 and 2·0 mL volumes of water were dripped into the pharynx under endoscopic examination of swallowing, and determine the latency time (LT) of the swallowing reflex elicited by water. The subjects were 51 bed-bound patients with dysphagia and could be divided into two groups as 35 tube feeding and 16 oral intake subjects. Among the tube feeding subjects, 20 patients who started dysphagia rehabilitation were followed-up to 3 months. Results The mean LT was 7·43 ± 7·19 seconds with 0·4 mL of test water and 5·05 ± 5·59 sec with 2·0 mL. When 0·4 mL water was dripped, LT was significantly longer in tube feeding (10·49 ± 7·97 seconds) than oral intake subgroup (5·72 ± 5·16 seconds) (p < 0·05). After the dietary intervention according to the result of FEES, 5 patients were improved in eating, and 15 patients were unchanged or even got worse among 3-months follow-up investigation. LT with 0.4 ml of test water of the Improved group was 3·16 ± 2·69 seconds and that of unchanged/worsened group was 22·6 ± 17·5 seconds, resulting in the significant difference (p < 0·05). Conclusions The results of this study suggest that our endoscopic swallowing test as swallowing provocation test with FEES is a useful examination for dysphagia rehabilitation.
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Affiliation(s)
- Chiharu Tejima
- Division of Clinical Oral Rehabilitation, the Nippon Dental University, Graduate School of Life Dentistry, Tokyo, Japan.
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, the Nippon Dental University, Graduate School of Life Dentistry, Tokyo, Japan. .,Division of Rehabilitation for Speech and Swallowing Disorders, the Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan.
| | - Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, the Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan.
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, the Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan.
| | - Mitsuyoshi Yoshida
- Dental Department, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan.
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Wang CM, Chen JY, Chuang CC, Tseng WC, Wong AMK, Pei YC. Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques. Geriatr Gerontol Int 2014; 15:736-44. [PMID: 25257507 DOI: 10.1111/ggi.12343] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 12/23/2022]
Abstract
AIM Previous studies have shown that the process of swallowing changes with aging, a phenomenon known as presbyphagia. These subtle and subclinical age-related changes make older adults more vulnerable to dysphagia during disease insults. However, there are limited studies of the swallowing process in older adults, because measurements are typically invasive or require exposure to X-rays. In the present study, we used integrated non-invasive measurements to determine aging-related changes of swallowing, and in the coordination of swallowing and respiration for a population of healthy participants. METHODS The non-invasive system provided measurements of larynx movement with piezoelectric sensors, submental muscle activity with surface electromyography and respiration-swallowing coordination by measurement of nasal airflow. We recruited 112 healthy participants from the community, 35 in a young-age group (age 20-30 years), 38 in a middle-age group (age 31-50 years) and 39 in an old-age group (age 51-70 years). RESULTS The oropharyngeal swallowing parameters of the old-age group had delayed onset latency and longer swallowing apnea duration relative to the other groups, and these differences were greater for larger boluses. The middle- and old-age groups had less expiratory-expiratory respiratory phase pattern than the young-age group. The probability of piecemeal deglutition was highest in the old-age group and lowest in the young-age group. These results show that the phases of oropharyngeal swallowing and the coordination of swallowing with respiration gradually change with aging. CONCLUSIONS We used integrated non-invasive measurements to document age-related changes in swallowing, and in the coordination of swallowing and respiration in healthy adults.
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Affiliation(s)
- Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Cheng Chuang
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
| | - Wen-Chun Tseng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Alice M K Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Kikutani T, Tamura F, Tashiro H, Yoshida M, Konishi K, Hamada R. Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents. Geriatr Gerontol Int 2014; 15:417-21. [PMID: 25130073 DOI: 10.1111/ggi.12286] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 01/15/2023]
Abstract
AIM Oral bacteria, which are a source of infection for aspiration pneumonia, were examined in frail older adults with the aim of establishing a standard bacteria count that indicates the risk of pneumonia onset in this group. METHODS A survey of bacteria count in the saliva using a simple instrument for measurement of the number of oral bacteria, along with factors including swallowing function and nutritional status, was carried out in 691 elderly individuals requiring care (137 men; mean age 82.6 ± 8.3 years; 554 women; mean age 88.0 ± 7.1 years; total mean age 86.7 ± 7.8 years) at 16 nursing homes in Japan. All participants gave their consent for inclusion in the present study. During a 6-month follow-up period, participants who developed pneumonia were identified, and relationships between the factors measured at the start of the period and pneumonia onset were examined. RESULTS During the 6-month follow-up period, 33 participants (4.8%; 5 men, 28 women; mean age 88.3 ± 7.4 years) developed pneumonia. Pneumonia onset was significantly associated with reduced activities of daily living, swallowing dysfunction and undernourishment. Logistic regression analysis identified a saliva bacteria count of 10(8.5) colony-forming units/mL as an independent explanatory factor for pneumonia onset (P = 0.012, RR = 3.759). CONCLUSIONS Oral bacteria count of 10(8.5) colony-forming units/mL saliva in an elderly person requiring care was identified as a risk factor for pneumonia onset.
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Affiliation(s)
- Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry at Tokyo, Japan; Division of Rehabilitation for Speech and Swallowing Disorders, Nippon Dental University Tama Oral Rehabilitation Clinic, Japan
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Hara K, Tohara H, Wada S, Iida T, Ueda K, Ansai T. Jaw-Opening Force Test to Screen for Dysphagia: Preliminary Results. Arch Phys Med Rehabil 2014; 95:867-74. [DOI: 10.1016/j.apmr.2013.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/30/2013] [Accepted: 09/09/2013] [Indexed: 12/17/2022]
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Wirth R, Smoliner C, Jäger M, Warnecke T, Leischker AH, Dziewas R. Guideline clinical nutrition in patients with stroke. EXPERIMENTAL & TRANSLATIONAL STROKE MEDICINE 2013; 5:14. [PMID: 24289189 PMCID: PMC4176491 DOI: 10.1186/2040-7378-5-14] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 11/22/2013] [Indexed: 01/04/2023]
Abstract
Stroke is regularly accompanied by dysphagia and other factors associated with decreased nutritional intake. Dysphagia with aspiration pneumonia and insufficient nutritional intake lead to worse outcome after stroke. This guideline is the first chapter of the guideline “Clinical Nutrition in Neurology” of the German Society for Clinical Nutrition (DGEM) which itself is one part of a comprehensive guideline about all areas of Clinical Nutrition. The thirty-one recommendations of the guideline are based on a systematic literature search and review, last updated December 31, 2011. All recommendations were discussed and consented at several consensus conferences with the entire DGEM guideline group. The recommendations underline the importance of an early screening and assessment of dysphagia and give advice for an evidence based and comprehensive nutritional management to avoid aspiration, malnutrition and dehydration.
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Affiliation(s)
- Rainer Wirth
- Department of Internal Medicine and Geriatrics, St, Marien-Hospital Borken, Am Boltenhof 7, D-46325 Borken, Germany.
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Morishita M, Mori S, Yamagami S, Mizutani M. Effect of Carbonated Beverages on Pharyngeal Swallowing in Young Individuals and Elderly Inpatients. Dysphagia 2013; 29:213-22. [DOI: 10.1007/s00455-013-9493-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 09/25/2013] [Indexed: 11/25/2022]
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Beom J, Han TR. Treatment of dysphagia in patients with brain disorders. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Simplified Cough Test for Screening Silent Aspiration. Arch Phys Med Rehabil 2012; 93:1982-6. [DOI: 10.1016/j.apmr.2012.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/25/2012] [Accepted: 05/20/2012] [Indexed: 11/19/2022]
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Abstract
Aspiration pneumonia is diagnosed upon confirmation of inflammatory findings in the lungs and overt aspiration (apparent aspiration) or a condition in which aspiration is strongly suspected (abnormal swallowing function and dysphagia). In hospital-acquired pneumonia, this occurs as one consequence of frequent silent aspiration. In the diagnosis of aspiration pneumonia, evaluation of the risk of silent aspiration during the night and evaluation of swallowing function are important. The causative microorganisms in aspiration pneumonia, similar to community-acquired pneumonia, are basically thought to be bacteria residing in the oral cavity, such as pneumococcus, Haemophilus influenzae, Staphylococcus aureus and anaerobes. Hospital-acquired aspiration pneumonia often occurs with no distinction between apparent and silent aspiration, and in many cases, aspiration of foreign substances is serious when dysphagia itself is severe. In the treatment of aspiration pneumonia, use of antimicrobials for the pneumonia itself and early measures to prevent aspiration are important.
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Abstract
AbstractAccurate screening of individuals who are at risk for oropharyngeal dysphagia is critically important because of the negative outcomes associated with the disorder. This article provides a review of a recently published study in which results of the 3-ounce water swallow test were compared with results of instrumental dysphagia testing. Clinical implications are discussed.
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Teramoto S. Novel preventive and therapuetic strategy for post-stroke pneumonia. Expert Rev Neurother 2009; 9:1187-200. [PMID: 19673607 DOI: 10.1586/ern.09.72] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pneumonia is a significant complication of ischemic stroke that increases mortality. Post-stroke pneumonia is defined as newly developed pneumonia following stroke onset. Clinically and chronologically, post-stroke pneumonia is divided into two types of aspiration pneumonia. First, acute-onset post-stroke pneumonia occurs within 1 month after stroke. Second, insidious or chronic-onset post-stroke pneumonia occurs 1 month after the stroke. The mechanisms of pneumonia are apparent aspiration and dysphagia-associated microaspiration. Stroke and the post-stroke state are the most significant risk factors for aspiration pneumonia. The preventive and therapeutic strategies have been developed thoroughly and appropriate antibiotic use, and both pharmacological and nonpharmacological approaches for the treatment of post-stroke pneumonia have been studied rigorously. Increases in substance P levels, oral care, and swallowing rehabilitation are necessary to improve swallowing function in post-stroke patients, resulting in a reduction in the incidence of post-stroke pneumonia in a chronic stage. The stroke must be a cause of aspiration pneumonia.
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Affiliation(s)
- Shinji Teramoto
- Department of Pulmonary Medicine, National Hospital Organization, Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan.
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Simple swallowing provocation test has limited applicability as a screening tool for detecting aspiration, silent aspiration, or penetration. Dysphagia 2009; 25:6-10. [PMID: 19626367 DOI: 10.1007/s00455-009-9222-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
A number of tests for evaluating dysphagia without using videofluoroscopic examination of swallowing (VF) or videoendoscopic evaluation of swallowing (VE) have been developed. The simple swallowing provocation test (SSPT) is unique because it is performed while in a supine position and does not require the patient's cooperation. However, whether the SSPT detects aspiration or penetration correctly is unclear because its validity determined by VF or VE has not been evaluated. Therefore, we determined the sensitivity, specificity, and predictive accuracy of SSPT followed by VF in 45 patients. The sensitivities of the first-step and the second-step SSPT for the detection of aspiration, silent aspiration, or penetration were 72-75% and 13-17%, respectively; the specificities of the first-step and the second-step SSPT were 38-44% and 80-89%, respectively; and the predictive accuracies of the first-step and the second-step SSPT were 58-67% and 31-49%, respectively. These data suggest that SSPT has limited applicability as a screening tool for aspiration, silent aspiration, or penetration because of its low sensitivity. This test may be useful for patients who cannot undergo other tests due to cognitive and/or linguistic dysfunction.
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Davis DP, Fakhry SM, Wang HE, Bulger EM, Domeier RM, Trask AL, Bochicchio GV, Hauda WE, Robinson L. Paramedic Rapid Sequence Intubation for Severe Traumatic Brain Injury: Perspectives from an Expert Panel. PREHOSP EMERG CARE 2009; 11:1-8. [PMID: 17169868 DOI: 10.1080/10903120601021093] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice. The interpretation of this panel can be summarized as follows: (1) the existing literature regarding paramedic RSI is inconclusive, and apparent differences in outcome can be explained by use of different methodologies and variability in comparison groups; (2) the use of Glasgow Coma Scale score alone to identify TBI patients requiring RSI is limited, with additional research needed to refine our screening criteria; (3) suboptimal RSI technique as well as subsequent hyperventilation may account for some of the mortality increase reported with the procedure; (4) initial and ongoing training as well as experience with RSI appear to affect performance; and (5) the success of a paramedic RSI program is dependent on particular EMS and trauma system characteristics.
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Affiliation(s)
- Daniel P Davis
- Department of Emergency Medicine, University of California at San Diego, San Diego, California 92103-8676, and Trauma Services, Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, VA, USA.
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Kolb G, Bröker M. State of the art in aspiration assessment and the idea of a new non invasive predictive test for the risk of aspiration in stroke. J Nutr Health Aging 2009; 13:429-33. [PMID: 19390749 DOI: 10.1007/s12603-009-0079-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dysphagia is a common but severe complication in acute stroke. New bedside tests are necessary to assess the risk of aspiration and avoid unnecessary alimentary restrictions but they must be completed by evaluated instruments. OBJECTIVE We evaluated the prognostic validity of the recognition of forms (rf) test related to the assessment by speech and language therapists (SLT). DESIGN Double blinded screening tests. SETTING Geriatric department of general hospital. SUBJECTS 50 patients with acute stroke admitted consecutively. METHODS All patients were assessed by SLT, mini mental status test, short test for assessing deficits of memory and attention and abilities of daily living-test. The rf-test was performed twice with a two week interval. RESULTS Assessment by SLT demonstrated aspiration in 29 of 50 patients. 18 patients failed the rf-test, giving a specificity of 90% (positive predictive value 89%), a sensitivity of 55% (negative predictive value 59%). 5 of 7 patients with aspiration pneumonia failed the test. Test-retest-correlation was 0,827. Performance in the rf-test was related significantly to results of the activities of daily living-test. CONCLUSIONS Bedside tests to exclude aspiration in patients with acute stroke are necessary. No test so far combines high sensitivity with acceptable specificity. Compared to other bedside tests the rf-test has a high specificity while sensitivity is low. On behalf of good predictivity rf-test may be an interesting supplement to swallow tests in case of stroke and seems to be a candidate for more extended studies.
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Affiliation(s)
- G Kolb
- St. Bonifatius-Hospital, Akad. Lehrkrankenhs, Med. Hochschule Hannover, Lingen/Ems.
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Dziewas R, Warnecke T, Hamacher C, Oelenberg S, Teismann I, Kraemer C, Ritter M, Ringelstein EB, Schaebitz WR. Do nasogastric tubes worsen dysphagia in patients with acute stroke? BMC Neurol 2008; 8:28. [PMID: 18651972 PMCID: PMC2507716 DOI: 10.1186/1471-2377-8-28] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 07/23/2008] [Indexed: 02/08/2023] Open
Abstract
Background Early feeding via a nasogastric tube (NGT) is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. Methods In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES). In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place. Results A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration. Conclusion Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
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Screening Test for Silent Aspiration at the Bedside. Dysphagia 2008; 23:364-70. [DOI: 10.1007/s00455-008-9150-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 01/11/2008] [Indexed: 11/25/2022]
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Suiter DM, Leder SB. Clinical Utility of the 3-ounce Water Swallow Test. Dysphagia 2007; 23:244-50. [PMID: 18058175 DOI: 10.1007/s00455-007-9127-y] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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Kitamura T, Nakase H, Iizuka H. Risk Factors for Aspiration Pneumonia after Percutaneous Endoscopic Gastrostomy. Gerontology 2007; 53:224-7. [PMID: 17356289 DOI: 10.1159/000100898] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 01/19/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is generally used for long-term enteral nutrition. Patients who require PEG placement are often very sick, and postoperative complications, especially aspiration pneumonia, can be fatal. OBJECTIVE In this study we investigated the risk factors for aspiration pneumonia after PEG using a simple two-step swallowing provocation test (S-SPT), as reported in 1999 by Teramoto et al. METHODS The study included 29 patients (10 men, 19 women; mean age 84.6 years) who underwent S-SPT before PEG. We evaluated the presence of reflux esophagitis (RE) and esophageal hiatal hernia (EHH) with PEG. According to the S-SPT results, a normal response to the 1st step S-SPT was given a score of 0, a normal response to the 2nd step S-SPT was given a score of 1, and an abnormal response to the 2nd step S-SPT was given a score of 3. In addition to S-SPT, the presence of RE was given a score of 3, the absence of RE was given a score of 0, the presence of EHH was given a score of 2, and the absence of EHH was given a score of 0. We evaluated the association between the presence of aspiration pneumonia, as an early and critical complication, up to 1 month after PEG and determined the total risk score (score of S-SPT+ score of RE+ score of EHH). RESULTS The group with an abnormal response to the 2nd step S-SPT and the group with RE both exhibited aspiration pneumonia. The patients with aspiration pneumonia all achieved total scores > or =3, and 8 of 13 patients without aspiration pneumonia achieved scores < or =2. CONCLUSIONS S-SPT is particularly useful in PEG patients. The scores provided by S-SPT and endoscopic examination can be very useful for aspiration pneumonia after PEG. The patients with scores < or =2 appear to be at very low risk for aspiration pneumonia, and patients with the scores > or =3 should be carefully followed up.
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Affiliation(s)
- Toshiro Kitamura
- Department of Surgery, Municipal Kouyo Hospital, Hokuto City, Yamanashi, Japan.
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Davis DP, Patel RJ. Noninvasive capnometry for continuous monitoring of mental status: a tale of 2 patients. Am J Emerg Med 2006; 24:752-4. [PMID: 16984855 DOI: 10.1016/j.ajem.2006.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 02/26/2006] [Indexed: 11/19/2022] Open
Affiliation(s)
- Daniel P Davis
- UCSD Emergency Medicine, Mercy Air Medical Services, UCSD Neuroanesthesia Laboratory, San Diego/UCSD Resuscitation Research Group, CA 92103-8676, USA
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Wang TG, Chang YC, Chen SY, Hsiao TY. Pulse oximetry does not reliably detect aspiration on videofluoroscopic swallowing study. Arch Phys Med Rehabil 2005; 86:730-4. [PMID: 15827925 DOI: 10.1016/j.apmr.2004.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the reliability of pulse oximetry for identifying aspiration by comparing it with the videofluoroscopic swallowing study (VFSS). DESIGN Nonrandomized, prospective, double-blind study. SETTING VFSS laboratory in a teaching hospital. PARTICIPANTS Sixty patients from among 130 patients with clinically diagnosed dysphagia between September and December 2002. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Simultaneously monitoring the arterial oxygen saturation (Sp o 2 ) by pulse oximetry while patients were performing VFSS. A decrease in Sp o 2 exceeding 3% was considered as significant desaturation. Bolus or portion of bolus passing through the vocal cords and entering the subglottic space was defined as aspiration on VFSS. The results of pulse oximetry and VFSS were compared. RESULTS No significant correlation existed between desaturation measured by pulse oximetry and aspiration on VFSS (chi 2 test, P =.87). The positive predictive rate of pulse oximetry in detecting aspiration on VFSS was 39.1%, and the negative predictive rate was 59.4%. CONCLUSIONS Aspiration occurring on VFSS cannot be predicted based on decrease in Sp o 2 in pulse oximetry. The application of pulse oximetry to detect aspiration during regular meals requires further investigation.
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Affiliation(s)
- Tyng-Guey Wang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, College of Medicine, and National Taiwan University, Taipei.
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Dziewas R, Ritter M, Schilling M, Konrad C, Oelenberg S, Nabavi DG, Stögbauer F, Ringelstein EB, Lüdemann P. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry 2004; 75:852-6. [PMID: 15145999 PMCID: PMC1739077 DOI: 10.1136/jnnp.2003.019075] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Aspiration pneumonia is the most important acute complication of stroke related dysphagia. Tube feeding is usually recommended as an effective and safe way to supply nutrition in dysphagic stroke patients. OBJECTIVE To estimate the frequency of pneumonia in acute stroke patients fed by nasogastric tube, to determine risk factors for this complication, and to examine whether the occurrence of pneumonia is related to outcome. METHODS Over an 18 month period a prospective study was done on 100 consecutive patients with acute stroke who were given tube feeding because of dysphagia. Intermediate outcomes were pneumonia and artificial ventilation. Functional outcome was assessed at three months. Logistic regression and multivariate regression analyses were used, respectively, to identify variables significantly associated with the occurrence of pneumonia and those related to a poor outcome. RESULTS Pneumonia was diagnosed in 44% of the tube fed patients. Most patients acquired pneumonia on the second or third day after stroke onset. Patients with pneumonia more often required endotracheal intubation and mechanical ventilation than those without pneumonia. Independent predictors for the occurrence of pneumonia were a decreased level of consciousness and severe facial palsy. The NIH stroke scale score on admission was the only independent predictor of a poor outcome. CONCLUSIONS Nasogastric tubes offer only limited protection against aspiration pneumonia in patients with dysphagia from acute stroke. Pneumonia occurs mainly in the first days of the illness and patients with decreased consciousness and a severe facial palsy are especially endangered.
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Affiliation(s)
- R Dziewas
- Department of Neurology, University Hospital of Münster, Muenster, Germany.
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Abstract
Swallowing problems are common in hospital inpatients and may affect morbidity and mortality. Accurate assessment of dysphagia is important, allowing optimal management and minimizing potential complications. This article considers the methods of swallow assessment available and ways in which problems can be addressed.
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Affiliation(s)
- D J Ramsey
- Department of Health Care of Older People, William Harvey Hospital, Ashford, Kent TN24 0LZ
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Teramoto S, Yamamoto H, Yamaguchi Y, Ouchi Y, Matsuse T. A Novel Diagnostic Test for the Risk of Aspiration Pneumonia in the Elderly. Chest 2004; 125:801-2. [PMID: 14769774 DOI: 10.1378/chest.125.2.801] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Xerez DR, Carvalho YSV, Costa MMB. Estudo clínico e videofluoroscópico da disfagia na fase subaguda do acidente vascular encefálico. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Correlacionar, em pacientes portadores de acidente vascular encefálico (AVE) na fase subaguda, as alterações clínicas da deglutição com as observadas na videofluoroscopia. MATERIAIS E MÉTODOS: De 37 portadores de AVE subagudo confirmado por exame de imagem, 26 pacientes de ambos os sexos, com idade média de 59,69 anos, foram avaliados clínica e videofluoroscopicamente. Consideramos como variáveis para pareamento estatístico os parâmetros clínicos indicativos de penetração/aspiração e sua confirmação na videofluoroscopia. RESULTADOS: Identificamos disfagia em 19 (73%) dos 26 pacientes que fizeram videofluoroscopia; dez (38,46%) apresentaram penetração/aspiração de líquidos. Os dados resultantes mostraram não existir correlação (p < 0,05) entre a presença de disfagia e/ou disartria e a presença de penetração/aspiração de líquidos na videofluoroscopia. Houve correlação entre a presença de penetração/aspiração de líquidos observados na videofluoroscopia com os seguintes parâmetros clínicos: estado dos dentes (p = 0,047), mobilidade (p = 0,019) e sensibilidade da face (p = 0,039) e mobilidade da língua (p = 0,012). CONCLUSÃO: Não foi possível definir a presença de penetração/aspiração de líquidos nas vias aéreas por dados epidemiológicos do AVE. A existência de mau estado de preservação dos dentes, alterações na mobilidade da face e da língua e na sensibilidade da face mostrou risco aumentado de penetração/aspiração para líquidos. Permanece importante a indicação da videofluoroscopia para melhor avaliação dos quadros de disfagia após AVE.
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Abstract
BACKGROUND AND PURPOSE Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians. METHODS An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted. RESULTS Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (kappa=0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (kappa=0 to 0.75) in the absence of assessor training. Fiberoptic endoscopy allows swallow assessment and sensory testing but requires specialized staff and equipment. Oxygen desaturation during swallowing may be predictive of aspiration (sensitivity, 73% to 87%; specificity, 39% to 87%) but is more useful in combination with bedside testing than in isolation. Other methods of swallow testing are invasive and require specialized staff and equipment. CONCLUSIONS Although bedside tests remain an important early screening tool for dysphagia and aspiration risk, further refinements are needed to improve their accuracy.
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Affiliation(s)
- Deborah J C Ramsey
- Department of Stroke Medicine, Guy's King's & St. Thomas' School of Medicine, King's College, London, UK.
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45
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Mokhlesi B. Altered Swallowing Physiology and Aspiration in COPD. Chest 2002. [DOI: 10.1016/s0012-3692(16)47227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Teramoto S, Kume H, Ouchi Y. Altered Swallowing Physiology and Aspiration in COPD. Chest 2002; 122:1104-5; author reply 1105. [PMID: 12226067 DOI: 10.1378/chest.122.3.1104] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gomes JA, Robins SJ, Babikian VL. Treatment of lipid disorders after stroke. Curr Atheroscler Rep 2002; 4:304-10. [PMID: 12052282 DOI: 10.1007/s11883-002-0012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The efficacy of lipid disorder therapy for the primary and secondary prevention of coronary heart disease is established. There are, however, no completed studies specifically directed at reducing the risk of stroke with lipid therapy. Although observational cohort studies have failed to demonstrate an association between lipid disorders and stroke incidence, recently completed trials of subjects at risk for coronary heart disease have shown that statins and fibric acid derivatives reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. Lipid drugs are well tolerated and treatment complications are relatively low. It seems prudent to conclude that the stroke patient with an undesirable lipid profile who has a history of coronary heart disease should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorders but no history of coronary heart disease; most should receive therapy for primary prevention of heart disease. Lipid treatment trials focused on stroke risk reduction are urgently needed.
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Affiliation(s)
- Joao A Gomes
- Department of Neurology, Boston University School of Medicine, Boston VA Medical Center, 150 South Huntington Avenue, Boston, MA 02130, USA
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Doggett DL, Turkelson CM, Coates V. Recent developments in diagnosis and intervention for aspiration and dysphagia in stroke and other neuromuscular disorders. Curr Atheroscler Rep 2002; 4:311-8. [PMID: 12052283 DOI: 10.1007/s11883-002-0010-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review discusses the impact of the evidence-based report on dysphagia diagnosis and treatment in stroke patients prepared in 1999 by ECRI under contract with the Agency for Healthcare Research and Quality (AHRQ). Subsequent research findings are highlighted and research design and reporting problems in the field are discussed. Progress has been made toward standardizing training and rating of videofluoroscopic studies of swallowing (VFSS); however, a consensus does not yet exist. A randomized, controlled trial demonstrated that treatment directed by fiber-optic endoscopic evaluation of swallowing with sensory testing (FEESST) or VFSS resulted in approximately equivalent pneumonia rates. These two different methods provide both overlapping and complementary information. There is discussion of the research design problems of mixed patients versus homogeneous populations, case-control diagnostic studies, inappropriate calculations of diagnostic sensitivity/specificity using imperfect "gold standards," the lack of concurrent control groups in treatment studies, and the misuse of statistical significance tests and P values in examining matching of patient characteristics in comparative studies and in identifying important variables in regression analysis.
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