title: 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.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Public university tertiary hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain; Rehabilitation Research Group, Biomedical Research Institute Hospital del Mar, Barcelona, Catalonia, Spain; Medicine Department, Universitat Autònoma de Barcelona, Catalonia, Spain. Electronic address: aguillen@parcdesalutmar.cat.
authors.forename: Anna
authors.initials: A
authors.lastname: Guillén-Solà
authors.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain.
authors.forename: Sandra Cecilia
authors.initials: SC
authors.lastname: Chiarella
authors.affiliation: Radiodiagnosis Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-Orfila
authors.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain; Rehabilitation Research Group, Biomedical Research Institute Hospital del Mar, Barcelona, Catalonia, Spain; Medicine Department, Universitat Autònoma de Barcelona, Catalonia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Duarte
authors.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain.
authors.forename: Martha
authors.initials: M
authors.lastname: Alvarado-Panesso
authors.affiliation: Radiodiagnosis Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Figueres-Cugat
authors.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Bas
authors.affiliation: Physical Medicine and Rehabilitation Department, Hospitals Mar-Esperança, Parc de Salut Mar, Barcelona, Catalonia, Spain; Rehabilitation Research Group, Biomedical Research Institute Hospital del Mar, Barcelona, Catalonia, Spain; Medicine Department, Universitat Autònoma de Barcelona, Catalonia, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Marco
mesh_terms: D000368:Aged; D019343:Citric Acid; D003371:Cough / Q000139:chemically induced*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D015203:Reproducibility of Results; D053120:Respiratory Aspiration / Q000503:physiopathology*; D020521:Stroke / Q000150:complications*; D014741:Video Recording
chemical_list: D019343:Citric Acid
keywords: Cough; Deglutition disorders; Diagnosis; Rehabilitation; Respiratory aspiration