Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia

Oba, Shoko; Tohara, Haruka; Nakane, Ayako; Tomita, Makoto; Minakuchi, Shunsuke; Uematsu, Hiroshi

doi:10.1007/s10266-016-0238-5

Cited by 14 publications

(18 citation statements)

References 35 publications

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“…15 Among swallowing screening tests for patients with acute pneumonia, the RSST (once or more every 30 s) has been reported to be the most useful test for determining whether to restart food intake. 15 The CPF sensitivity, specificity, and area under the curve for evaluating the risk of aspiration when restarting food intake were similar to the RSST values, and there was no significant difference especially for the area under the curve (P ϭ .42), which suggests that the precision of CPF is not inferior to that of the RSST, which is a conventional swallowing screening test. The sensitivity, specificity, and area under the curve might have been similar between CPF and the RSST because the glottic closure is involved in both CPF and the RSST.…”

Section: Cutoff Values and Sensitivity/specificity Of Rsst Results Anmentioning

confidence: 99%

“…26 The cutoff value of each test was considered as the value of the point closest to the upperleft corner along the ROC. 15 For data analysis, calculations were performed with descriptive statistics (mean Ϯ SD). All analyses were performed using SPSS 24.0 (IBM Corp, Armonk, New York) and the statistical package R 3.1.0 (R Project for Statistical Computing, Vienna, Austria).…”

Section: Discussionmentioning

confidence: 99%

“…Among dysphagia screening tests that are used to evaluate whether oral food intake should be restarted in patients with acute pneumonia, the RSST (cutoff value, once) has been reported to be the most useful due to its sensitivity of 81% and specificity of 67%. 15 However, the RSST does not adequately detect micro-aspiration or silent aspiration; thus, it is important to identify the presence of the coughing reflex and the cough strength required to expel aspirated foreign objects. 16 Cough peak flow (CPF) has gained attention as an objective indicator of cough strength and has been used to evaluate the cough strength in various diseases.…”

Section: Introductionmentioning

confidence: 99%

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Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

2019

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BACKGROUND: The incidence of community-acquired pneumonia (CAP) is relatively high in elderly subjects. Cough peak flow (CPF) is an objective indicator of cough strength, and CPF evaluation might be useful to assess whether food intake can be restarted. We aimed to examine whether cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP. METHODS: This cross-sectional study included 82 elderly subjects with CAP between August 2016 and March 2018. CPF was measured using a peak flow meter, and we performed the repetitive saliva-swallowing test (RSST), which is a videoendoscopic evaluation of swallowing and is used to assess dysphagia and aspiration. Receiver operating characteristic (ROC) curve analysis was performed. The cutoff value was determined, and the area under the ROC was calculated. RESULTS: The areas under the RSST and CPF curves were 0.87 and 0.83, respectively. The RSST value for identifying the aspiration risk was 2.5 swallows. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 70.0%, 71.7%, 2.5, and 0.42, respectively. The CPF for identifying the aspiration risk was 190 L/min. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 82.6%, 69.4%, 2.7, and 0.25, respectively. CONCLUSIONS: Our findings suggest that cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP and that CPF evaluation is not inferior to the RSST. However, CPF evaluation should be performed together with swallowing screening tests to determine the aspiration risk.

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Section: Cutoff Values and Sensitivity/specificity Of Rsst Results Anmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

2019

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“…In addition, eating and swallowing function were assessed by 81.2% of all respondents, and by virtually all (96.6%) of respondents providing dysphagia rehabilitation. Multiple-choice responses on the content of assessment among respondents practicing assessment revealed that a medical interview was performed by 96.4% of respondents and that a screening test including a repetitive saliva swallowing test (4,5), modified water swallowing test (6)(7)(8), and food test (6) was performed by 93.8% of respondents (Fig. 3B).…”

Section: Content Of Ddcmentioning

confidence: 99%

Trends in domiciliary dental care including the need for oral appliances and dental technicians in Japan

Kamijo

Sugimoto

Oki

et al. 2018

Journal of Oral Science

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The need for domiciliary dental care (DDC) for people requiring long-term nursing care is increasing as the super-aged society of Japan grows still older. Dysphagia diagnosis and rehabilitation are becoming more important in DDC; thus, the need for prostheses used for dysphasia rehabilitation is presumed to be increasing. To identify DDC trends in Japan, as well as the need for prostheses and dental technicians for DDC, we sent a selfadministered questionnaire to dentists providing DDC and analyzed responses from 138 dentists (valid response rate, 39.8%). The results showed that 37.7% of respondents reported treating ≥50 patients per month. The most frequently performed procedures were removable prosthetic treatment and oral care, followed by dysphagia rehabilitation. Use of palatal augmentation prostheses was experienced by 54.3% of respondents, and most indicated that the prostheses were effective for improvement of oropharyngeal function. The rates of cooperation with primary care doctors and nursing care professionals were 76.8% and 85.5%, respectively. Only 6.5% of respondents reported accompanying dental technicians to DDC.The present analysis of trends in DDC indicates that oral care and dysphagia rehabilitation have become more frequent and that cooperation with healthcare professionals other than dental technicians has increased in recent DDC.

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“…The RSST is used for screening dysphagia, and one of the methods for assessment of swallowing function, as well as the tongue pressure [15]. The RSST is a predictor of aspiration [23,24]. The decrease in tongue pressure may also be a predictor of aspiration in patients after esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Change in tongue pressure and the related factors after esophagectomy: a short-term, longitudinal study

et al. 2019

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Background Dysphagia is a prominent symptom after esophagectomy and may cause aspiration pneumonia. Swallowing evaluation after esophagectomy can predict and help control the incidence of postoperative pneumonia. The aim of this study was to clarify whether the change in tongue pressure was associated with any related factor and postoperative dysphagia/pneumonia in patients with esophageal cancer after esophagectomy. Methods Fifty-nine inpatients (41 males and 18 females; 33-77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure and the repetitive saliva swallowing test (RSST) was performed before esophagectomy (baseline) and at 2 weeks postoperatively. The general data were collected from patients' medical records, including sex, age, type of cancer, cancer stage, location of cancer, operative approach, history of previous chemotherapy, surgical duration, amount of bleeding during surgery, incidences of postoperative complications, intubation period, period between surgery and initiation of oral alimentation, and intensive care unit (ICU) stay, blood chemical analysis, and lifestyle. Results Tongue pressure decreased significantly after esophagectomy (p = 0.011). The decrease of tongue pressure was significantly associated with length of ICU stay and preoperative tongue pressure on multiple regression analysis (p < 0.05). The decrease of tongue pressure in the RSST<3 or postoperative pneumonia (+) group was significantly greater than in the RSST≥3 (p = 0.003) or pneumonia (-) group (p = 0.021). Conclusions The decrease in tongue pressure was significantly associated with the length of ICU stay, preoperative tongue pressure, and the incidence of dysphagia and pneumonia among inpatient after esophagectomy.

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Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia

Cited by 14 publications

References 35 publications

Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

Trends in domiciliary dental care including the need for oral appliances and dental technicians in Japan

Change in tongue pressure and the related factors after esophagectomy: a short-term, longitudinal study

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