Usefulness of citric cough test for screening of silent aspiration in subacute stroke patients: a prospective study.

Abstract

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.

• Authors: Anna Guillén-Solà, Sandra Cecilia Chiarella, Juan Martínez-Orfila, Esther Duarte, Martha Alvarado-Panesso, Antoni Figueres-Cugat, Núria Bas, Ester Marco
• Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 96 Issue 7 Pg. 1277-83 (Jul 2015) ISSN: 1532-821X [Electronic] United States
• PMID: 25782622 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Citric Acid

Topics

• Aged
• Citric Acid
• Cough (chemically induced)
• Deglutition Disorders (diagnosis, etiology)
• Female
• Fluoroscopy
• Hospitals, University
• Humans
• Male
• Middle Aged
• Physical Therapy Modalities
• Prospective Studies
• Reproducibility of Results
• Respiratory Aspiration (physiopathology)
• Stroke (complications)
• Video Recording