Risk factors for aspiration pneumonia in patients with dysphagia undergoing videofluoroscopic swallowing studies

Abstract

Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia. Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated. One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93–5.41), smoking history (OR = 2.63, 95% CI: 1.53–4.53), underweight status (OR = 2.27, 95% CI: 1.31–3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01–2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11–6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73. The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.

Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis

“…37 Evidence from previous research findings have also revealed fluid penetration and aspiration status as important risk factors for all-cause mortality when conducting instrumental swallowing evaluations in patients with PSD. 38 Our study reported no difference in reducing aspiration/penetration among the combined and single neurostimulation and traditional dysphagia therapies possibly due to limited number of included studies for aspiration/penetration in the current NMA. Thus, more future studies are needed to address this issue and further investigation towards the mortality rate, incidence of aspiration pneumonia, and nutritional status among patients with PSD will be essential.…”

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

“…Dysphagia develops in over half of patients with acute stroke [ 1 ]. Dysphagia is a major risk factor for aspiration pneumonia in stroke patients [ 2 ]. The incidence of aspiration pneumonia in stroke patients with dysphagia is reported to be 20–47% [ 3 , 4 ].…”

BTS clinical statement on aspiration pneumonia

“…[17][18][19] The proportion of people with risk factors for AP is increasing. [20][21][22][23] AP is consistently associated with older age. 20 24-27 Up to a quarter of care home residents are at risk for AP at any given time.…”

“…Abnormal swallowing is caused by a variety of neurological, muscular or GI disorders and is unequivocally associated with increased risk of AP 17–19. The proportion of people with risk factors for AP is increasing 20–23…”