title: Cough reflex testing in Dysphagia following stroke: a randomized controlled trial.
abstract: BACKGROUND
  Significant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial.
  
  
  METHODS
  Patients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management.
  
  
  RESULTS
  Analysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001).
  
  
  CONCLUSIONS
  Despite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved.
authors.affiliation: Department of Communication Disorders, The University of Canterbury, 66 Stewart St, Christchurch 8011, New Zealand ; Speech Science, School of Psychology, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Anna
authors.initials: A
authors.lastname: Miles
authors.forename: Irene S L
authors.initials: IS
authors.lastname: Zeng
authors.forename: Helen
authors.initials: H
authors.lastname: McLauchlan
authors.forename: Maggie-Lee
authors.initials: ML
authors.lastname: Huckabee
keywords: Cough reflex testing; Deglutition; Deglutition disorders; Dysphagia; Pneumonia; Silent aspiration; Stroke care