[Dysphagia] re: silent aspiration

[Jennie.Morgan at cddah.nhs.uk (Morgan Jennie (RXP) Speech & Language Therapy)]

Unfortunately, aspiration leading to pneumonia is something which is almost impossible to measure.

By necessity, measures to prevent aspiration and pneumonia always intervene between the diagnostic test and the ultimate gold standard for judging correctness of the test, whether pneumonia occurs (Dogget, Tappe, Mitchell, Chapell, Coates and Turkelson, 2001). Any success in preventing pneumonia changes true-positive results to false-positive (e.g. risk of pneumonia was predicted but did not occur). The true diagnostic abilities for predicting pneumonia risk cannot be known, so none of the available studies claiming to assess this diagnostic ability are reliable.

Jennie

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of naomislp@aol.com
Sent: 14 December 2005 14:19
To: dysphagia@b9.com
Subject: [Dysphagia] re: silent aspiration


I agree this is a difficult question but we are all out in the field, trying to manage these problems without very clear direction from the research. Practically speaking, we may not be able to predict exactly when aspiration will lead to pneumonia but it seems reasonable to predict that a set of certain conditions will make certain pts more vulnerable to potential negative effects from aspiration than others - e.g., bed-ridden pt, with compromised nutrition, running fevers, perhaps admitted for resp failure, currently on trach, vent-dependent, etc.... probably wouldn't be able to manage even small amount of aspiration. Is this an incorrect assumption? Do we have any more precise way of predicting aspiration outcomes?
 
Naomi
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