Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets

Sakamoto, Torao; Horiuchi, Akira; Makino, Toshiyuki; Kajiyama, Masashi; Tanaka, Naoki; Hyodo, Masamitsu

doi:10.4253/wjge.v8.i6.288

Cited by 25 publications

(27 citation statements)

References 14 publications

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“…To assess the usefulness of cough strength evaluation for determining aspiration risk, subjects with an FEES total score of Ն 7 points were classified into a restricted oral intake group, and those with an FEES total score Ͻ 7 points were classified into an unrestricted oral intake group, according to a previous report. 25 Initially, the chi-square test and Mann-Whitney U test were used to compare age, sex, body mass index, CPF, respiratory frequency, tidal volume, % VC, % FEV 1 , RSST results, CURB-65 scores, and medical history between the restricted oral intake and unrestricted oral intake groups. Subsequently, the aspiration risk determination predictive power (ie, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) was assessed using RSST results and CPF as independent variables and FEES results as dependent variables, with receiver operating characteristic curve (ROC) analysis.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

2019

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“…Endoscopic swallowing scoring was used to evaluate the total swallowing function with videoendoscopy ( Table 2 ). 8 , 9 The endoscopic swallowing scoring consists of four swallowing components: 1) salivary pooling in vallecula and pyriform sinuses, 2) the response of glottal closure reflex induced by touching the epiglottis with endoscope, 3) location of the bolus at the time of swallowing onset assessed by endoscopic whiteout and 4) the extent of pharyngeal clearance after swallowing of blue-dyed water. Each item was scored on a scale of 0–3 as shown in Table 2 , and the sum of each score was used as an index of total swallowing function.…”

Section: Methodsmentioning

confidence: 99%

“…Clinically, the full score is 12, and a score of more than 7 indicates a serious risk for aspiration, while a score of 7 or less during endoscopic swallowing evaluation with test jelly reliably predicts the ability to eat pureed diets. 9 …”

Section: Methodsmentioning

confidence: 99%

Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study

Kondo¹,

Jinnouchi²,

Nakano³

et al. 2017

CIA

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ObjectiveThe aim of this study was to assess whether aural stimulation with ointment containing capsaicin improves swallowing function in elderly patients with dysphagia.Study designA randomized, placebo-controlled, double-blind, comparative study.SettingsSecondary hospital.Patients and methodsTwenty elderly dysphagic patients with a history of cerebrovascular disorder or Parkinson’s disease were randomly divided into two groups: 10 receiving aural stimulation with 0.025% capsaicin ointment and 10 stimulated with placebo. The ointments were applied to the external auditory canal with a cotton swab. Then, swallowing of a bolus of blue-dyed water was recorded using transnasal videoendoscopy, and the swallowing function was evaluated according to both endoscopic swallowing scoring and Sensory-Motor-Reflex-Clearance (SMRC) scale.ResultsThe sum of endoscopic swallowing scores was significantly decreased 30 and 60 min after a single administration in patients treated with capsaicin, but not with placebo. Reflex score, but not Sensory, Motion and Clearance scores, of the SMRC scale was significantly increased 5, 30 and 60 min after single administration in patients treated with capsaicin, but not with placebo. No patient showed signs of adverse effects.ConclusionAs capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1), these findings suggest that improvement of the swallowing function, especially glottal closure and cough reflexes, in elderly dysphagic patients was due to TRPV1-mediated aural stimulation of vagal Arnold’s nerve with capsaicin, but not with a nonspecific mechanical stimulation with a cotton swab.

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“…Postoperative pneumonia is the third most common complication for all surgical procedures and is associated with increased patient morbidity and mortality 18) . Additionally, pneumonia is the fourth most common cause of mortality in the elderly in Japan 16) . Numerous studies have tried to clarify the risk factors linked to PRC, such as postoperative airway obstruction and pneumonia, older age, male gender, smoking, obesity, chronic obstructive pulmonary disease, bleeding disorders, an increased number of fused vertebral levels, blood loss, and prolonged operative durations 6,9,[19][20] .…”

Section: Discussionmentioning

confidence: 99%

“…1. This system has been reported as reliable and useful for evaluating the severity and features of dysphagia 12,16) .…”

Section: Evaluations Of Dysphagiamentioning

confidence: 99%

Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

Ohba

Akaike

Fujita

et al. 2021

Spine Surg Relat Res

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Introduction: Postoperative respiratory complications (PRC) are one of the most serious complications. Potentially life-threatening accidents can occur after an anterior cervical discectomy and fusion (ADF), such as airway obstruction and aspiration pneumonia. Despite numerous studies, preoperative predictive and preventive methodology has yet to be established. As reported in our previous study, the evaluation of preoperative dysphagia using the eating assessment tool (EAT-10) and a flexible endoscopic evaluation of swallowing (FEES) is useful for predicting the incidence and risk factors of dysphagia after ADF. Methods: This prospective study comprised 60 consecutive patients who underwent ADF. An otolaryngologist and a speech-language-hearing therapist preoperatively and 1 week postoperatively evaluated dysphagia using EAT-10 and Hyodo-Komagane (H-K) scores during FEES. Patient demographics, comorbidities, and pre-and postoperative dysphagia were compared between patients with and without PRC. Results: Seven of 60 (11.6%) patients had preoperative dysphagia diagnosed using the H-K score. A significant positive correlation existed between the pre-and postoperative H-K scores. Of all 60 cases, eight (13.3%) had PRC. Among them, two required reintubation due to airway obstruction and six had aspiration pneumonia. The PRC(+) group was significantly older and more prone to diabetes and asthma. The preoperative H-K score of the PRC(+) group was significantly higher than that of the PRC(−) group. Postoperatively, but not preoperatively, EAT-10 was significantly higher in the PRC(+) group. Conclusions: Preoperative dysphagia may potentially exacerbate postoperative dysphagia after ADF. A preoperative evaluation of dysphagia using the H-K score during FEES is a useful method for predicting and reducing the risk of PRC.

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Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets

Abstract: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

Cited by 25 publications

References 14 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

Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study

Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

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