Anna Guillén-Solà1, Sandra Cecilia Chiarella2, Juan Martínez-Orfila3, Esther Duarte4, Martha Alvarado-Panesso2, Antoni Figueres-Cugat3, Núria Bas2, Ester Marco4. 1. Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain; Rehabilitation Research Group, Biomedical Research Institute Hospital del Mar, Barcelona, Catalonia, Spain; Medicine Department, Universitat Autònoma de Barcelona, Catalonia, Spain. Electronic address: aguillen@parcdesalutmar.cat. 2. Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain. 3. Radiodiagnosis Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain. 4. Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain; Rehabilitation Research Group, Biomedical Research Institute Hospital del Mar, Barcelona, Catalonia, Spain; Medicine Department, Universitat Autònoma de Barcelona, Catalonia, Spain.
Abstract
OBJECTIVE: To detect silent aspiration in a homogeneous sample of stroke patients using the citric acid cough test. DESIGN: Prospective study. SETTING: Public university tertiary hospital. PARTICIPANTS: Consecutive subacute stroke patients (N=134; 74 men, 60 women; mean age ± SD, 62.2±11.9y; 11.7±9.9d after stroke) who had complained of dysphagic symptoms, referred for rehabilitation from December 2010 to October 2012. INTERVENTION: All patients were administered a citric acid cough test and underwent a videofluoroscopic swallowing study (VFSS). A reduced or an absent response on the citric acid cough test was considered when cough peaks were ≤4. A control group of healthy volunteers was also screened. MAIN OUTCOME MEASURES: The citric acid cough test results were compared with the VFSS results, which were used as a criterion standard. RESULTS: There were 36 patients with a positive citric acid cough test, of which the VFSS revealed penetration in 14 cases (38.9%), aspiration in 5 (13.9%), silent aspiration in 5 (13.9%), and normality in 12 patients (33.3%). The sensitivity and specificity indexes for the reliability of citric acid cough test as a screening method for silent aspiration in comparison with the VFSS were .19 and .71, respectively. Other comparisons were made between silent aspirators (Penetration Aspiration Scale=8) and different subgroups of patients, but values remained poor. CONCLUSIONS: The citric acid cough test using 1.0 (weight by volume)% for 1 minute does not seem to be a useful standalone tool to screen for silent aspiration in subacute stroke patients with suspected dysphagia.
OBJECTIVE: To detect silent aspiration in a homogeneous sample of strokepatients using the citric acid cough test. DESIGN: Prospective study. SETTING: Public university tertiary hospital. PARTICIPANTS: Consecutive subacute strokepatients (N=134; 74 men, 60 women; mean age ± SD, 62.2±11.9y; 11.7±9.9d after stroke) who had complained of dysphagic symptoms, referred for rehabilitation from December 2010 to October 2012. INTERVENTION: All patients were administered a citric acid cough test and underwent a videofluoroscopic swallowing study (VFSS). A reduced or an absent response on the citric acid cough test was considered when cough peaks were ≤4. A control group of healthy volunteers was also screened. MAIN OUTCOME MEASURES: The citric acid cough test results were compared with the VFSS results, which were used as a criterion standard. RESULTS: There were 36 patients with a positive citric acid cough test, of which the VFSS revealed penetration in 14 cases (38.9%), aspiration in 5 (13.9%), silent aspiration in 5 (13.9%), and normality in 12 patients (33.3%). The sensitivity and specificity indexes for the reliability of citric acid cough test as a screening method for silent aspiration in comparison with the VFSS were .19 and .71, respectively. Other comparisons were made between silent aspirators (Penetration Aspiration Scale=8) and different subgroups of patients, but values remained poor. CONCLUSIONS: The citric acid cough test using 1.0 (weight by volume)% for 1 minute does not seem to be a useful standalone tool to screen for silent aspiration in subacute strokepatients with suspected dysphagia.