Article

OBJECTIVE: To detect silent aspiration in a homogeneous sample of stroke patients
using the citric acid cough test. DESIGN: Prospective study. SETTING: Public
university tertiary hospital. PARTICIPANTS: Consecutive subacute stroke patients
(N=134; 74 men, 60 women; mean age +/- SD, 62.2+/-11.9y; 11.7+/-9.9d after
stroke) who had complained of dysphagic symptoms, referred for rehabilitation
from December 2010 to October 2012. INTERVENTION: All patients were administered
a citric acid cough test and underwent a videofluoroscopic swallowing study
(VFSS). A reduced or an absent response on the citric acid cough test was
considered when cough peaks were </=4. A control group of healthy volunteers was
also screened. MAIN OUTCOME MEASURES: The citric acid cough test results were
compared with the VFSS results, which were used as a criterion standard. RESULTS:
There were 36 patients with a positive citric acid cough test, of which the VFSS
revealed penetration in 14 cases (38.9%), aspiration in 5 (13.9%), silent
aspiration in 5 (13.9%), and normality in 12 patients (33.3%). The sensitivity
and specificity indexes for the reliability of citric acid cough test as a
screening method for silent aspiration in comparison with the VFSS were .19 and
.71, respectively. Other comparisons were made between silent aspirators
(Penetration Aspiration Scale=8) and different subgroups of patients, but values
remained poor. CONCLUSIONS: The citric acid cough test using 1.0 (weight by
volume)% for 1 minute does not seem to be a useful standalone tool to screen for
silent aspiration in subacute stroke patients with suspected dysphagia.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS