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Otsubo H, Okita I, Suzuki M, Nakanishi S, Asai H, Inaoka PT. The Kuchi-kara Taberu index as a predictive marker of oral intake recovery in patients with aspiration pneumonia. Geriatr Gerontol Int 2023; 23:221-226. [PMID: 36748651 DOI: 10.1111/ggi.14551] [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: 09/02/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
AIM In recent years, the Kuchi-kara Taberu (KT) index has been used as a new tool for the evaluation of dysphagia; however, its predictive ability remains unknown. This study was conducted to examine the validity of oral intake recovery prediction using the KT index in patients with aspiration pneumonia. METHODS The subjects were older inpatients admitted to an acute-care hospital for the treatment of aspiration pneumonia. A logistic regression analysis was conducted to clarify factors significantly associated with oral intake recovery. In addition, cut-off values of the predictors were calculated using a receiver operating characteristic curve analysis with the area under the curve (P < 0.05). RESULTS A total of 124 patients (mean age 84.3 ± 7.9 years old, 70 males, 54 females) were enrolled in this study and divided into two groups at discharge: the oral intake group (62.1%) and the non-oral intake group (37.9%). The significant predictors of the recovery of oral intake were the pre-treatment period, treatment period, and the total score of the KT index; the respective odds ratios were 1.082 (95% confidence interval [CI] 1.013-1.156), 1.018 (1.003-1.033) and 0.850 (0.780-0.927), and the respective areas under the curve were 0.407 (95% CI 0.300-0.515), 0.304 (0.208-0.399), and 0.732 (0.640-0.824). The cut-off value of the total score of the KT index was 30. The model showed 85.7% sensitivity and 57.4% specificity. CONCLUSION The KT index is suggested to be a valid variable for predicting whether or not a patient with aspiration pneumonia can recover their oral intake ability during acute-care hospitalization. Geriatr Gerontol Int 2023; 23: 221-226.
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Affiliation(s)
- Hisanori Otsubo
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Ikumi Okita
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan
| | - Madoka Suzuki
- Department of Rehabilitation, Kanazawa City Hospital, Kanazawa, Japan
| | - Sayaka Nakanishi
- Department of Otorhinolaryngology, Kanazawa City Hospital, Kanazawa, Japan
| | - Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Science School of Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Pleiades T Inaoka
- Department of Physical Therapy, Graduate Course of Rehabilitation Science School of Health Sciences, Kanazawa University, Kanazawa, Japan
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Furukawa D, Yamanaka Y, Kasai H, Urushibara T, Ishiwata T, Muranishi S. Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset. PLoS One 2022; 17:e0267119. [PMID: 35421190 PMCID: PMC9009697 DOI: 10.1371/journal.pone.0267119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 03/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Elderly inpatients who develop fevers after resumption of oral intake are often considered to have aspiration pneumonia (AP) and be tentatively fasted. Fasting has been associated with prolonged hospital stays and decreased swallowing ability. The purpose of this study was to compare AP and other infections after resumption of oral intake in elderly inpatients and to identify the clinical characteristics. Patients and methods The records of patients who were admitted to a public tertiary hospital and referred for evaluation of swallowing disability were retrospectively reviewed to identify those who had developed AP, non-AP, or urinary tract infection (UTI) after resumption of oral intake. Eligible patients were enrolled consecutively in the study. The patient characteristics, physical findings, laboratory data, oral intake status at the time of onset of symptoms, and rate of discontinuation of oral intake after onset of infection were compared between the three types of infection. Results A total of 193 patients developed an infectious illness after resuming oral intake. Among them, 114 patients had a diagnosis of AP (n = 45), non-AP (n = 24), or UTI (n = 45). There were no significant differences in patient characteristics, physical findings or laboratory data between the group with AP and the other two groups. AP developed at a median of 6 (range 1–16) days after resumption of oral intake. The rate of discontinuation of oral intake was 91.1% in the AP group, 58.3% in the non-AP group, and 26.7% in the UTI group, respectively. Conclusion Infectious diseases other than AP should be considered in the differential diagnosis when nosocomial fever develops in elderly inpatients more than 17 days after resuming oral intake. Furthermore, nosocomial fever after resuming oral intake has many causes other than AP, and discontinuation of oral intake should be carefully considered.
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Affiliation(s)
- Daisuke Furukawa
- Department of Rehabilitation, Kimitsu Chuo Hospital, Kisarazu, Japan
- * E-mail:
| | - Yoshitaka Yamanaka
- Department of Rehabilitation, Kimitsu Chuo Hospital, Kisarazu, Japan
- Department of Neurology, Urayasu Rehabilitation Education Center, Chiba University Hospital, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Kimitsu Chuo Hospital, Kisarazu, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Tomokazu Ishiwata
- Department of Rehabilitation, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Sachiyo Muranishi
- Department of Rehabilitation, Kimitsu Chuo Hospital, Kisarazu, Japan
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Inamoto Y, Kaneoka A. Swallowing Disorders in the Elderly. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-021-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Satheeshkumar PS, Papatheodorou S, Sonis S. Enhanced oral hygiene interventions as a risk mitigation strategy for the prevention of non-ventilator-associated pneumonia: a systematic review and meta-analysis. Br Dent J 2020; 228:615-622. [PMID: 32332964 PMCID: PMC7223037 DOI: 10.1038/s41415-020-1452-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Healthcare-acquired pneumonias are a significant risk for nursing home and hospital patients. While oral care interventions (OCIs) have been found to be effective in reducing the risk of ventilator-associated pneumonia (VAP), their utility in mitigating non-ventilator-associated pneumonias (NVAP) remains unknown. We performed a structured meta-analysis of randomised and non-randomised clinical trials of enhanced oral hygiene procedures on NVAP.Methods We searched PubMed and Embase to include clinical trials (randomised and non-randomised), and observational (retrospective and prospective) and quasi-experimental studies examining the effect of any method of OCI on incidence of NVAP.Results After quality assessment and consensus agreement between authors, we synthesised six randomised clinical trials (3,891 patients), two non-randomised trials (2,993 patients), and separately assessed a retrospective trial (143 patients) and a quasi-experimental study (83 patients). Most studies, performed in nursing homes, did not show a significant association between OCI and NVAP prevention (RR random 0.89, 95% CI 0.64-1.25, p value 0.50). Likewise, the non-randomised trials failed to show an association between NVAP risk and OCI (RR random 1.42, 95% CI, 0.70-2.88, p value 0.32). However, in the subgroup analysis comparing dental professional involvement in care vs usual care, reduced NVAP risk was demonstrated (RR random 0.65, 95% CI 0.43-0.98, p value 0.03).Conclusions Study results suggest that professional dental care may confer some benefit among NVAP patients. The lack of consistent OCI protocols, data in hospitalised patients and robust randomised clinical trials do not allow definitive conclusions about the contribution of OCI in mitigating NVAP risk.
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Affiliation(s)
| | | | - Stephen Sonis
- Primary Endpoint Solutions, Watertown MA, USA; Brigham and Women's Hospital, Boston, MA, USA
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Kimura M, Nakayama E, Ogawa Y, Sato M, Inagawa M, Watanabe M, Sato M, Naganuma A, Ogawa T, Ueda K. Prediction of oral intake recovery for inpatients with aspiration pneumonia by videoendoscopic evaluation using the Hyodo-Komagane score in Japan. J Oral Rehabil 2020; 48:55-60. [PMID: 33025615 DOI: 10.1111/joor.13108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To verify the validity of the prediction of oral intake recovery for inpatients with aspiration pneumonia using the Hyodo-Komagane score. BACKGROUND Patients admitted for treatment of aspiration pneumonia sometimes have difficulty in resuming oral intake due to decreased swallowing function. Predicting whether the swallowing function will recover enough to achieve oral ingestion at discharge is an important factor in developing a treatment strategy. No studies have investigated the prediction of oral intake recovery using videoendoscopic examination. METHODS Subjects were 65 patients who were admitted to an acute care hospital for the treatment of aspiration pneumonia. The patients were divided into two groups, the oral feeding group and the tube feeding group, according to their oral intake status at discharge or transfer. Logistic regression analysis was performed using the condition that tube feeding was not required as an objective variable and the items with significant differences between the two groups as explanatory variables. Additionally, the receiver operating characteristic curve was used to identify patients who could take food orally at discharge. RESULTS The odds ratios for the Hyodo-Komagane score and the pharyngeal clearance score were 1.485 and 3.379, respectively. When the cut-off values of the Hyodo-Komagane score and the pharyngeal clearance score were 6 and 1, the sensitivity was 0.88 and 0.91, and the specificity was 0.64 and 0.70, respectively. CONCLUSION The Hyodo-Komagane score and especially the pharyngeal clearance score are useful indices to predict oral intake recovery for inpatients with aspiration pneumonia.
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Affiliation(s)
- Masanori Kimura
- Nihon University School of Dentistry, Tokyo, Japan.,National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | | | - Yusuke Ogawa
- National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Mari Sato
- National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Motoaki Inagawa
- National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Mao Watanabe
- Nihon University School of Dentistry, Tokyo, Japan.,Hikone Municipal Hospital, Hikone, Japan
| | | | - Atsushi Naganuma
- National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Tetsushi Ogawa
- National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
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Honda Y, Momosaki R, Ogata N. Nasogastric Tube Feeding Versus Total Parenteral Nutrition in Older Dysphagic Patients with Pneumonia: Retrospective Cohort Study. J Nutr Health Aging 2020; 24:883-887. [PMID: 33009540 DOI: 10.1007/s12603-020-1414-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Many older patients with pneumonia cannot intake orally after admission and may need nutritional care such as nasogastric tube feeding or total parenteral nutrition. This study sought to compare in-hospital outcomes between patients receiving nasogastric tube feeding and total parenteral nutrition. DESIGN This is a retrospective cohort study. SETTING A hospital-based database constructed by the Diagnosis Procedure Combination survey data comprising more than 100 acute-care hospitals. PARTICIPANTS The study included consecutive older inpatients aged >65 years admitted to participating hospitals with a diagnosis of pneumonia from 2014 through 2017. MEASUREMENTS We compared patients who received total parenteral nutrition and those who received nasogastric tube feeding in terms of characteristics and outcomes. RESULTS Among the included inpatients, a total of 336 (73.2%) patients received total parenteral nutrition and 123 (26.8%) patients received nasogastric tube feeding. Patients with nasogastric tube feeding had less in-hospital mortality (13.8% vs 27.1%, p = 0.003) and a smaller number of complications (mean; 0.71 vs 1.44, p <0.001), shorter length of hospital stay (mean; 27.6 vs 48.9, p <0.001), more discharges home (72.4% vs 35.1%, p <0.001), and more discharges without oral intake (65.9% vs 45.8%, p <0.001) than patients with total parenteral nutrition. The same results were obtained in propensity score analysis. CONCLUSIONS Older patients with pneumonia treated with total parenteral nutrition were significantly more likely to have higher in-hospital mortality than those receiving nasogastric tube feeding.
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Affiliation(s)
- Y Honda
- Ryo Momosaki, MD, PhD, MPH, Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan, Tel: +81 59 232 1111; Fax: +81 59 231 5661, E-mail:
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