title: Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke.
abstract: Improved diagnostic tests that can accurately identify subjects at high risk for aspiration pneumonia (AP) are needed. One measure of this accuracy is the false-negative rate (FNR), which determines the failure of a test to identify a group at high risk. This study compares FNRs for AP among dysphagic stroke patients for two prognostic techniques: modified barium swallow (MBS) alone and MBS combined with laryngopharyngeal sensory discrimination testing (MBS + LPSDT). MBS and LPSDT were performed within 4 weeks of stroke in 20 subjects who were prospectively followed for at least 2 years to identify the frequency of AP. MBS identified 10 patients as not at risk based on the finding of no aspiration on initial MBS; four of these patients developed AP (FNR = 40%). MBS + LPSDT identified five patients as not at risk based on the findings of neither aspiration nor bilateral sensory deficits; none of these patients developed AP (FNR = 0%). The combination of MBS criterion (aspiration) with the LPSDT criterion (bilateral sensory deficits) improves prognostication of outcome in dysphagic stroke patients by identifying a subgroup at high risk for developing AP (nonaspirators with bilateral deficits).
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Columbia-Presbyterian Medical Center College of Physicians and Surgeons, Columbia University, New York, New York 10032, U.S.A.
authors.forename: J E
authors.initials: JE
authors.lastname: Aviv
authors.forename: R L
authors.initials: RL
authors.lastname: Sacco
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: J L
authors.initials: JL
authors.lastname: Thompson
authors.forename: B
authors.initials: B
authors.lastname: Levin
authors.forename: S
authors.initials: S
authors.lastname: Sunshine
authors.forename: J
authors.initials: J
authors.lastname: Thomson
authors.forename: L G
authors.initials: LG
authors.lastname: Close
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000628:therapy; D003287:Contrast Media; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D005188:False Negative Reactions; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007823:Laryngeal Nerves / Q000503:physiopathology; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012018:Reflex / Q000502:physiology; D012307:Risk Factors; D012677:Sensation / Q000502:physiology*; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012684:Sensory Thresholds / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate