• Arch Phys Med Rehabil · Jul 2015

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

    • Anna Guillén-Solà, Sandra Cecilia Chiarella, Juan Martínez-Orfila, Esther Duarte, Martha Alvarado-Panesso, Antoni Figueres-Cugat, Núria Bas, and Ester Marco.
    • 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.
    • Arch Phys Med Rehabil. 2015 Jul 1; 96 (7): 1277-83.

    ObjectiveTo detect silent aspiration in a homogeneous sample of stroke patients using the citric acid cough test.DesignProspective study.SettingPublic university tertiary hospital.ParticipantsConsecutive 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.InterventionAll 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 MeasuresThe citric acid cough test results were compared with the VFSS results, which were used as a criterion standard.ResultsThere 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.ConclusionsThe 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.Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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