Predicting Aspiration in Patients With Ischemic Stroke: Comparison of Clinical Signs and Aerodynamic Measures of Voluntary Cough.

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Predicting Aspiration in Patients With Ischemic Stroke: Comparison of Clinical Signs and Aerodynamic Measures of Voluntary Cough.

Chest. 2008 Nov 18;

Authors: Smith Hammond CA, Goldstein LB, Horner RD, Ying J, Gray L, Gonzalez-Rothi L, Bolser DC

Background Clinical signs often fail to identify stroke patients at increased risk of aspiration. We hypothesized that objective measures of voluntary cough would better predict those at risk. Methods A comprehensive diagnostic evaluation was completed for 96 consecutive stroke patients that included cognitive testing, a bedside clinical swallow examination, aerodynamic and sound pressure level measures of voluntary cough, and "gold standard" instrumental swallowing studies (videofluoroscopy, VSE or fiberoptic endoscopy, FEES). Stroke severity was assessed retrospectively using the Canadian Neurologic Scale. Results Based on VSE/FEES, 33 patients (34%) were at high risk of aspiration and (66%) were nonaspirators. Clinical signs (absent swallow, difficulty handling secretions or reflexive cough after water bolus) had an overall accuracy of 74% with a sensitivity of 58% and a specificity of 83% for the detection of aspiration. Three objective measures of voluntary cough (expulsive phase rise time; volume acceleration, and expulsive phase peak flow) were each associated with aspiration risk category (areas under the curves, AUCs, were 0.93, 0.92 and 0.86, respectively). Expulsive phase rise time >/= 55 m/s, volume acceleration < 50 L/s/s, and expulsive phase peak flow < 2.9 L/s had sensitivities of 91%, 91%, and 82%, and specificities of 81%, 92% and 83% for the identification of aspirators. Conclusion Objective measures of voluntary cough can identify stroke patients at risk for aspiration and may be useful as an adjunct to the standard bedside clinical assessment.

PMID: 19017886 [PubMed - as supplied by publisher]

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