Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals

Nakashima, Takeshi; Maeda, Keisuke; Tahira, Kanae; Taniguchi, Kousuke; Mori, Kumiko; Kiyomiya, Hiroyasu; Akagi, Junji

doi:10.1111/ggi.13250

Cited by 36 publications

(27 citation statements)

References 22 publications

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“…In this sense, DREPs presented high sensitivity and specificity to identify the risk of aspiration/penetration. The objective of a swallowing screening tool is to identify as many cases of dysphagia as possible before penetration and/or aspiration (sensitivity) may occur, which can cause negative impacts including mortality (1,(6)(7) . Considering the results of this study, we can affirm that DREPs fulfills this purpose.…”

Section: Discussionmentioning

confidence: 99%

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Precisão diagnóstica para o risco de broncoaspiração em população heterogênea

Lima

Sassi

Medeiros

et al. 2020

CoDAS

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RESUMO Objetivo: O objetivo do presente estudo foi realizar a validação de um instrumento simples de triagem da disfagia utilizado em um hospital público de grande porte no Brasil em população adulta heterogênea. Método: O Protocolo de Avaliação de Risco para Disfagia versão de triagem (PARDt) contém quatro itens (ausculta cervical alterada, alteração da qualidade vocal, tosse e engasgo antes/durante/após a deglutição) que foram previamente indicados como fatores de risco independentes associados à presença de disfagia no teste de deglutição com água. Fonoaudiólogos treinados administraram e classificaram o PARDt para pacientes consecutivos encaminhados pela equipe médica do hospital para realizar a videofluoroscopia da deglutição (VDF). Resultados: 211 pacientes foram submetidos ao PARDt: 99 falharam e 112 passaram. Um em cada cinco pacientes foram randomicamente selecionados para VDF. O PARDt apresentou excelente validade: sensibilidade de 92,9%; especificidade de 75,0%; valores preditivos negativos de 95,5%; acurácia de 80,9%. Conclusão: O PARDt é uma ferramenta simples e precisa para identificar o risco de penetração e/ou aspiração em pacientes que não são alimentados por sonda, que apresentam bom nível de alerta, sem histórico de pneumonias de repetição, que não estejam em vigência de pneumonia e que não façam uso de cânula de traqueostomia.

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Section: Discussionmentioning

confidence: 99%

“…The literature describes that dysphagia increases the length of hospital stay in all age groups (5) , as well as the risk of mortality (1,(6)(7) . The impact on hospital resources is substantial, because aspiration leads to the need of using antibiotics and orotracheal intubation (5,8) .…”

Section: Introductionmentioning

confidence: 99%

Precisão diagnóstica para o risco de broncoaspiração em população heterogênea

Lima

Sassi

Medeiros

et al. 2020

CoDAS

View full text Add to dashboard Cite

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“…It is therefore reasonable to presume that the antibiotic treatment was ineffective, but mechanical POHC was effective, in the recovery from aspiration pneumonia in this case. Currently, POHC is recommended for the prevention of fever and aspiration pneumonia in older adults; however, no clear evidence exists that it can suppress the exacerbation of aspiration pneumonia [1][2][3][4][5][6]. There is some evidence that POHC can contribute to a better quality of life by improving oral complications such as halitosis, xerostomia, and oral infectious diseases in the terminal stages of systemic diseases [15].…”

Section: Case Reports In Dentistrymentioning

confidence: 99%

“…Professional oral health care (POHC) prevents aspiration pneumonia caused by aspiration in older adults, especially when it is associated with dysphagia [1][2][3][4][5][6]. However, there is little evidence that POHC intervention after illness improves severe aspiration pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Continuous Professional Oral Health Care Intervention Improves Severe Aspiration Pneumonia

Nawata

Umezaki

Yamaguchi

et al. 2019

Case Reports in Dentistry

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Professional oral health care (POHC) is known to prevent aspiration pneumonia in patients with dysphagia and/or those at the perioperative stage of surgery. However, the effect of POHC on patients suffering from aspiration pneumonia remains unknown. Here, we report a case where continual POHC intervention improved severe aspiration pneumonia. A 74-year-old male patient with a brain infarction suffered from severe aspiration pneumonia (PSI: IV, A-DROP: 3) complicated by vascular dementia and severe dysphagia. Because an antimicrobial approach following the treatment guidelines for pneumonia was not effective, we started a POHC intervention to improve his poor oral condition at the request of the attending doctor and the patient's family. The severe pneumonia markedly improved after continual POHC by the dental team. This case suggests that continual POHC intervention by a dental hygienist may improve severe aspiration pneumonia.

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“…The risk of mortality owing to poor oral health in outof-hospital settings have been extensively studied; however, to our knowledge, despite the existence of several studies on oral care intervention in a hospital setting, studies investigating the association between poor oral health and mortality within a hospital setting are lacking [9,10]. Previously, we demonstrated the possible relationship between oral health at hospital admission and mortality in patients with aspiration pneumonia [11]. One major point of concern regarding the studies investigating the association between oral health and mortality is that most previous studies evaluated oral health only based on dental problems such as the number of teeth, existing periodontitis of the gum, or tooth caries; however, poor oral health can also be identified by considering multiple factors including the condition of the tongue, lips, and saliva.…”

Section: Introductionmentioning

confidence: 98%

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Maeda

2020

BMC Geriatr

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Background: Poor oral health at hospital admission is a potential higher mortality risk predictor. We aimed to determine in-hospital mortality by assessing poor oral health using a validated tool. Methods: A retrospective observational study was conducted in an acute care hospital, and 624 consecutive geriatric patients were included. Patients were divided into three groups according to oral health, stratified by the Oral Health Assessment Tool (OHAT) scores. Nutritional status, daily living activities, cognitive impairment, and comorbidities were collected as covariates. Univariate and multivariate analyses were performed to identify the relationship between oral health and survival. Results: The mean age was 83.8 ± 7.9 years, and 41% were males. Groups with an OHAT score equivalent to 0, 1-2, and ≥ 3 comprised 213, 206, and 205 patients, and 11 (5.2%), 13 (6.3%), and 37 (18.0%) of those patients died in the hospital, respectively. Patients in the OHAT score ≥ 3 group had higher mortality than those in the other groups (log-rank test: p = 0.012 for the OHAT = 0 group; p = 0.010 for the OHAT = 1-2 group after Bonferroni corrections). Patients in the OHAT score ≥ 3 group continued to have poor survival even after adjusting for confounders in the Cox's regression analysis (hazard ratio: 2.514, 95% confidence interval: 1.220-5.183, p = 0.012). Conclusion: In geriatric patients, poor oral health at hospital admission was an independent in-hospital mortality predictor. Future studies on oral care intervention stratified by oral health conditions are warranted.

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Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals

Cited by 36 publications

References 22 publications

Precisão diagnóstica para o risco de broncoaspiração em população heterogênea

Precisão diagnóstica para o risco de broncoaspiração em população heterogênea

Continuous Professional Oral Health Care Intervention Improves Severe Aspiration Pneumonia

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

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