Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion

Abstract

Although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke. In addition, few researches on the risk factors of aspiration pneumonia in patients with subacute and chronic stroke undergoing rehabilitation in the rehabilitation unit have been rarely conducted. In this study, therefore, we investigated whether a radionuclide salivagram could predict aspiration pneumonia, and tried to find other clinical factors that may be helpful in predicting aspiration pneumonia in stroke patients undergoing rehabilitation in the rehabilitation department.From March 2013 and January 2018, a retrospective review of the medical records of 1182 subacute and chronic stroke patients who were admitted to rehabilitation department (South Korea) was carried out. We included 117 stroke patients with swallowing difficulties who were admitted to our rehabilitation department and satisfied our criteria retrospectively. Stroke lesion, the degree of paralysis, sex, age, onset duration, feeding methods, the Mini-Mental State Examination (MMSE), the Global Deterioration Scale (GDS), the presence of aspiration in VFSS or salivagram, the penetration-aspiration scale (PAS), and the total score of the Modified Barthel Index (MBI) were investigated by reviewing medical records.To evaluate the predictor of aspiration pneumonia for patients with stroke, multivariate logistic regression analysis with forward stepwise was performed. In the results of this study, only MMSE was significant as a clinical predictor, but not aspiration in VFSS or salivagram in multivariate analysis of supratentorial stroke patients (OR, 0.895) (95% CI, 0.830–964). In multivariate analysis of infratentorial stroke patients, combined results of salivagram and VFSS (aspiration in a salivagram or VFSS) (OR, 0.956) (95% CI, 0.919–995), and total MBI scores were significant as clinical predictors (OR, 24.882) (95% CI, 1.298–477.143).In conclusion, MMSE can be a clinical predictor of the occurrence of aspiration pneumonia in patients with supratentorial stroke. In contrast, total MBI score and combined results of a salivagram and VFSS can be clinical predictors of the occurrence of aspiration pneumonia in patients with infratentorial stroke.

Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

“…Among critically ill patients, stroke patients are susceptible to HAP not only in patients at the early stage but also in the recovery period; furthermore, the incidence of this acquired pneumonia among stroke patients is signi cantly higher than that of the general patient population [6,27]. In the past 10 years, SAP has been widely recognized by clinical researchers [2-4, 7, 9].…”

Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies

“…A retrospective investigation was conducted to investigate the presence of aspiration pneumonia in patients with dysphagia. We reviewed the data for the presence of aspiration pneumonia 1 month before and after the VFSS [9,10]. The following data were investigated: symptoms such as fever, dyspnea, or sputum; coughing during feeding; findings on chest radiograph; hematological laboratory findings (white blood cell (WBC) counts, Creactive protein (CRP) level, and erythrocyte sedimentation rate (ESR)); and the use of antibiotics [9,10].…”

“…It is difficult to make a definitive diagnosis of aspiration pneumonia because the diagnostic criteria is different across various studies. Thus, patients who met all the following criteria were considered to have aspiration pneumonia in this study: (1) the presence of both subjective symptoms (fever, cough, and increased purulent sputum production) and objective signs (the presence of lung infiltrates on chest radiography, coarse lung sounds, and systemic inflammation based on hematological laboratory findings such as increased CRP levels and WBC counts), (2) clinical suspicion of an aspiration event (coughing during swallowing or increased time for swallowing), and (3) no evidence of microorganisms, such as legionella or mycoplasma, which are common pathogens of atypical pneumonia [9,10]. In addition, the clinical reports from the Department of Internal Medicine were used for the diagnosis of aspiration pneumonia [9,10].…”

Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia

“…[12,13] The following data were collected: symptoms, such as coughing during feeding; the presence of sputum, dyspnea, or fever; chest X-ray ndings; blood laboratory ndings (white blood cell [WBC] counts, C-reactive protein [CRP] level, and erythrocyte sedimentation rate); and use of antibiotics. [12,13] Although a de nitive diagnosis of aspiration is di cult and the diagnostic criteria for aspiration pneumonia are slightly different across studies, patients who met all of the following criteria were considered to have aspiration pneumonia in the present study: (1) the presence of both objective signs (coarse lung sounds, the presence of lung in ltration on chest X-ray, and systemic in ammation based on blood laboratory ndings, such as increased CRP levels and WBC counts) and subjective symptoms (fever, cough, and increased purulent sputum), (2) clinical suspicion of aspiration (delayed swallowing or coughing during swallowing), and (3) no evidence of microorganisms, such as Legionella or Mycoplasma, which are common pathogens in atypical pneumonia. [12,13] In addition, the clinical reports from the Internal Medicine Department were used to diagnose aspiration pneumonia.…”