[Updated on Apr. 18] Integration of CiNii Articles into CiNii Research

Development of Risk Assessment Algorithm for Aspiration Pneumonia in Acute Phase of Stroke

DOI
  • YAMANE Yukiko
    Kyoto Prefectural University of Medicine, Department of Homecare Medicine
  • KAMAKURA Yayoi
    School of Nursing & Health, Aichi Prefectural University
  • FUKADA Junko
    School of Nursing & Health, Aichi Prefectural University
  • KATAOKA Emiko
    Department of Nursing, Japanese Red Cross Nagoya Daini Hospital
  • YASUI Keizo
    Department of Neurology, Japanese Red Cross Nagoya Daini Hospital
  • HASEGAWA Yasuhiro
    Department of Neurology, Japanese Red Cross Nagoya Daini Hospital
  • HATANO Norikazu
    Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital
  • SEKI Yukio
    Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital

Bibliographic Information

Other Title
  • 脳卒中急性期における誤嚥性肺炎のリスク評価アルゴリズムの開発
  • ノウソッチュウ キュウセイキ ニ オケル ゴエンセイ ハイエン ノ リスク ヒョウカ アルゴリズム ノ カイハツ

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Abstract

<p>Purpose: The aim of this study was to develop an algorithm to assess the risk of developing aspiration pneumonia.</p><p>Subjects: Among those who were urgently admitted to the study hospital between April and August 2013 within 5 days after the onset of cerebral infarction or cerebral hemorrhage and who received conservative treatment without endotracheal intubation, we obtained consent for 160 patients to enter the study either directly from them or their families.</p><p>Methods: We performed this study with the approval of the study ethical review board of Aichi Prefectural University and the study hospital. We collected basic data on subjects as well as relevant data regarding aspiration pneumonia from the medical records. Physical examination, intraoral observation, bacterial count, and tongue fluid volume measurements were carried out every other day from the 2nd through 14th hospital day. All subjects were grouped into either a pneumonia group or a non-pneumonia group based on definite. Subsequently, based on the algorithm, we determined the aspiration pneumonia risk and calculated the sensitivity and specificity, defining the pneumonia group as the gold standard.</p><p>Results: One hundred and sixty subjects were classified into the pneumonia group (23 subjects; 16 developed aspiration pneumonia and 7 developed suspected aspiration pneumonia) and the non-pneumonia group (137 subjects). Fourteen subjects (87.5%) developed aspiration pneumonia by the 5th hospital day, for which we took particular note of the 2nd and 4th hospital days. Those determined as aspiration pneumonia-risk individuals by physical examination of the algorithm were 57 subjects on the 2nd hospital day and 60 subjects on the 4th hospital day. While the sensitivity and the specificity were 0.86 and 0.71 on the 2nd hospital day, they were 0.75 and 0.67 on the 4th hospital day, respectively. When there was tongue coating and secretion in the oral cavity on the 2nd hospital day, both the sensitivity and the specificity were 0.75. The inter-rater reliability on assessing each physical examination data was 82.0 to 95.3%, thus verifying reliability.</p><p>Conclusion: We developed an algorithm for assessing the risk of aspiration pneumonia, and showed that the algorithm appears to be valid. When subjects with aspiration risk were screened using the algorithm on the 2nd hospital day, sensitivity was 0.86 and specificity was 0.71. Furthermore, when tongue coating and secretion in the oral cavity were observed, both the sensitivity and specificity were 0.75.</p>

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