Archives of rehabilitation research and clinical translation · 2025
Validation of the Fiberoptic Endoscopy Evaluation of Swallowing in Aspiration Pneumonia: Utility of the Hyodo Dysphagia Score in Predicting the Development of Aspiration Pneumonia.
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Ibe Yoko, Tazawa Masayuki, Arii Hironori, Nakao Yumiko, Toyama Risa, Wada Naoki
Аннотация
OBJECTIVE: To analyze the characteristics of flexible endoscopic evaluation of swallowing (FEES) findings in patients with aspiration pneumonia using the Hyodo dysphagia score and to evaluate the risk of aspiration pneumonia.
DESIGN: Retrospective study.
SETTING: Observation in a single primary care institution.
PARTICIPANTS: Inpatients aged ≥20 years who underwent FEES in our hospital between April 2012 and March 2022. A total of 178 patients were eligible to calculate the Hyodo dysphagia score and were enrolled in this study. The mean ± SD age of the subjects was 73.4±13.3 years, and 116 of 178 patients (65.2%) were men.
INTERVENTION: Not applicable.
MAIN OUTCOME MEASURES: The development of aspiration pneumonia.
RESULTS: Eighty-four of 178 patients (47.2%) developed aspiration pneumonia. Age, oral intake status, and serum albumin levels were not significantly different between the pneumonia and nonpneumonia groups. The total and each parameter of the Hyodo dysphagia score were significantly higher in the pneumonia group than in the nonpneumonia group. Logistic regression analysis showed that salivary retention (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.09-1.33; P=.016) and poor cough reflex (OR, 1.88; 95% CI, 1.42-2.49; P<.001) in the Hyodo dysphagia score were risk factors for aspiration pneumonia. The area under the curve of the receiver operating characteristic curve for the onset of pneumonia based on the total Hyodo dysphagia score was 0.75 (95% CI, 0.67-0.82). A cutoff value of 5 for the total Hyodo dysphagia score gave a sensitivity of 0.75 (95% CI, 0.67-0.83) and a specificity of 0.60 (95% CI, 0.49-0.71), with the Youden index having a maximum value of 0.35.
CONCLUSIONS: A cutoff value of 5 points for the total Hyodo dysphagia score was optimal in predicting the development of aspiration pneumonia. Salivary retention and poor cough reflex were risk factors for the development of pneumonia.
DESIGN: Retrospective study.
SETTING: Observation in a single primary care institution.
PARTICIPANTS: Inpatients aged ≥20 years who underwent FEES in our hospital between April 2012 and March 2022. A total of 178 patients were eligible to calculate the Hyodo dysphagia score and were enrolled in this study. The mean ± SD age of the subjects was 73.4±13.3 years, and 116 of 178 patients (65.2%) were men.
INTERVENTION: Not applicable.
MAIN OUTCOME MEASURES: The development of aspiration pneumonia.
RESULTS: Eighty-four of 178 patients (47.2%) developed aspiration pneumonia. Age, oral intake status, and serum albumin levels were not significantly different between the pneumonia and nonpneumonia groups. The total and each parameter of the Hyodo dysphagia score were significantly higher in the pneumonia group than in the nonpneumonia group. Logistic regression analysis showed that salivary retention (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.09-1.33; P=.016) and poor cough reflex (OR, 1.88; 95% CI, 1.42-2.49; P<.001) in the Hyodo dysphagia score were risk factors for aspiration pneumonia. The area under the curve of the receiver operating characteristic curve for the onset of pneumonia based on the total Hyodo dysphagia score was 0.75 (95% CI, 0.67-0.82). A cutoff value of 5 for the total Hyodo dysphagia score gave a sensitivity of 0.75 (95% CI, 0.67-0.83) and a specificity of 0.60 (95% CI, 0.49-0.71), with the Youden index having a maximum value of 0.35.
CONCLUSIONS: A cutoff value of 5 points for the total Hyodo dysphagia score was optimal in predicting the development of aspiration pneumonia. Salivary retention and poor cough reflex were risk factors for the development of pneumonia.