Chest
Original ResearchCoughPredicting Aspiration in Patients With Ischemic Stroke: Comparison of Clinical Signs and Aerodynamic Measures of Voluntary Cough
Section snippets
Materials and Methods
Subjects were consecutive consenting patients who had recently experienced an ischemic stroke who were admitted to the Durham (NC) Veterans Affairs Medical Center (DVAMC) between November 2000 and November 2002 in whom the necessary tests could be scheduled (n = 96). Patients with a history of radiation therapy to the head and neck, brain tumor, or brain surgery were excluded. The Institutional Review Board of the DVAMC approved the study protocol.
Subject characteristics including comorbidities
Results
The results of the VSE or FEES are listed in Table 1. Thirty-three subjects (34%) were classified as being at high risk for aspiration (penetration aspiration scale score, ≥ 5), and 63 subjects were nonaspirators (penetration aspiration scale score, ≤ 4). The interrater reliability for the instrumental swallow evaluations was 0.88 (95% confidence interval [CI], 0.82 to 0.92), reflecting excellent agreement.
Table 2 summarizes the subjects' demographic and clinical characteristics categorized by
Discussion
The primary finding of this analysis is that two of the objective measures of voluntary cough, expulsive phase rise time and volume acceleration, are independently associated with aspiration risk as measured by the VSE or FEES, which are tests generally considered to be “gold standards.” The prevalence of aspiration in this cohort was consistent with that reported in other studies4, 5, 6 of similarly aged acute stroke patients that also used the VSE, suggesting that our results are likely
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This study was supported by the Department of Rehabilitation, Research and Development Service, Veterans Affairs National Headquarters.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).