Utilidad de un método a la cabecera del paciente para la detección de episodios aspirativos

Abstract

Objective deglutition disorders are an increasing problem, especially in ageing inpatients. Diagnosis of these disorders is usually achieved by complementary tests such as deglutition videofluoroscopy and fiberoptic endoscopic evaluation of swallowing. We aimed to identify the utility of a bedside method to detect aspiration episodes. Material and methods we prospectively evaluated the positive and negative likelihood ratios of the following four clinical signs: voice tone changes, the presence of cough, inability to keep food in the mouth, and a decrease in arterial oxygen saturation (SpO2), measured by pulse oximetry in adult patients hospitalized for any cause with suspicion of aspiration episodes. As gold standard deglutition videofluoroscopy and fiberoptic endoscopic evaluation of solid and liquid swallowing were used. The evaluation was performed by two independent operators blind to the gold standard. Results twenty patients (12 women and 8 men) with suspicion of aspiration were included. The mean age was 82.7 years. The reason for hospitalization was suspicion of aspirative pneumonia in 40% and stroke in 28%. No significant positive or negative likelihood ratios (1 ≥ 95% confidence interval ≥ 1) were found for the bedside method in comparison with either deglutition videofluoroscopy or fiberoptic endoscopic evaluation of solid and liquid swallowing for any of the four clinical signs or for either of the 2 operators. The interoperator agreement was poor (kappa < 0,3). Conclusions the bedside method is neither useful nor reproducible in detecting aspiration episodes.