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Int J Med Sci 2023; 20(3):429-436. doi:10.7150/ijms.76448 This issue Cite

Research Paper

Videofluoroscopy dysphagia severity scale is predictive of subsequent remote pneumonia in dysphagia patients

Poyin Huang, MD, PhD^1,2,3,4,5,6, Yi-Chiung Hsu, PhD⁷, Chien-Hsun Li, MD^1,2,3,5,8, Sun-Wung Hsieh, MD^1,2,3,4,5, Kuo-Wei Lee, MD^1,2, Kun-Han Wu, MD^1,2, Wen-Ching Chen, MD^9,✉, Chung-Wei Lin, MD^10,✉, Chun-Hung Chen, MD^1,2,3,5,6✉

1. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
2. Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
3. Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
4. Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
5. Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
6. Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
7. Department of Biomedical Sciences and Engineering, National Central University, Chung-Li, Taoyuan City 320, Taiwan.
8. Integrated Center of Healthy and Long-term Care, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan.
9. Department of general medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
10. School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
* Wen-Ching Chen, Chung-Wei Lin and Chun-Hung Chen are corresponding authors with equal contributions.

✉ Corresponding author: 1. Wen-Ching Chen, MD. Department of general medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Phone: 886-7-8717-0917, Fax: 886-7806-5068, E-mail: claire1209scom. 2. Chung-Wei Lin, MD. School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Phone: 886-7-6530-6668, Fax: 886-7806-5068, E-mail: russellcwlincom. 3. Chun-Hung Chen, MD. Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung city 812, Taiwan. TEL: 886-7-8036783 ext. 3453, Fax: 886-7- 8059125, E-mail: mp245hinet.net. More

Abstract

Introduction: Dysphagia-associated pneumonia is a critical health issue especially in the elders and stroke patients which carries a poorer prognosis. Therefore, we aim to identify methods with the potentials to predict subsequent pneumonia in dysphagia patients, which will be of great value in the prevention and early management of pneumonia.

Methods: One-hundred dysphagia patients were enrolled and measurements including Dysphagia Severity Scale (DSS), Functional Oral Intake Scale (FOIS), Ohkuma Questionnaire, and Eating Assessment Tool-10 (EAT-10) were assessed by either videofluoroscopy (VF), videoendoscopy (VE), or the study nurse. The patients were categorized into mild or severe groups based on each screening method. All the patients were assessed for pneumonia at 1, 3, 6, and 20 months after the examinations.

Results: VF-DSS (p=0.001) is the only measurement being significantly associated with subsequent pneumonia with sensitivity and specificity of 0.857 and 0.486. The Kaplan-Meier curves revealed that significant differences between the mild/severe groups start to emerge 3 months after VF-DSS (p=0.013). Cox regression models used for adjusted hazard ratio of severe VF-DSS in association with subsequent pneumonia of different timepoints after controlling the important covariates showed the following results: 3 months, p=0.026, HR=5.341, 95%CI=1.219-23.405; 6 months, p=0.015, HR=4.557, 95%CI=1.338-15.522; 20 months, p=0.004, HR=4.832, 95%CI=1.670-13.984.

Conclusions: Dysphagia severity evaluated by VE-DSS, VE-FOIS, VF-FOIS, Ohkuma Questionnaire, and EAT-10 is not associated with subsequent pneumonia. Only VF-DSS is associated with both short-term and long-term subsequent pneumonia. In patients with dysphagia, VF-DSS is predictive of subsequent pneumonia.

Keywords: videofluoroscopy, Dysphagia Severity Scale, dysphagia, pneumonia

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