Model based on clinical characteristics to identify patients with neurogenic oropharyngeal dysphagia
DOI:
https://doi.org/10.15649/cuidarte.3861Keywords:
Deglutition, Deglutition Disorders, Central Nervous System Diseases, Neuromuscular Diseases, Signs and Symptoms, Case-Control StudiesAbstract
Highlights
- Neurogenic oropharyngeal dysphagia is a category of dysphagia, usually caused by neurological and neuromuscular entities.
- The clinical evaluation of swallowing is an important tool in terms of its detection and characterization, which can be improved with models that integrate clinical variables.
- The integration of clinical variables derived from medical history, symptoms, signs on physical examination of swallowing, and signs after oral food testing can be integrated into clinical models.
- A binary logistic regression model was obtained with a good capacity to explain the phenomenon called neurogenic oropharyngeal dysphagia, powered by nine clinical variables.
Introduction: Neurogenic oropharyngeal dysphagia is a form of functional dysphagia usually caused by neurological and neuromuscular diseases, which produces several secondary complications. To improve its detection and characterization, models are emerging that integrate clinical variables to complement the physical examination of swallowing. Objective: Develop an explanatory model to differentiate patients with neurogenic oropharyngeal dysphagia. Materials and Methods: Case-control study based on a set of data derived from the clinical examination of swallowing with neurological emphasis carried out in a sample of patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes (cases), and in healthy people (controls). Results: 158 clinical variables were compared between both groups, where those with the greatest classification capacity were identified, integrated into an explanatory binary logistic regression model made up of nine variables: two history, two symptoms, three physical examination signs and two signs after consistency/volume test with food. The dependent variable was the category of being healthy or patient and the covariates were the clinical variables. Parameters reached by the model: Akaike information criterion 102 and Nagelkerke R2 0.78. Discussion: The nine variables that entered the model, together, largely explain the presence of neurogenic oropharyngeal dysphagia, and are accessible by physical examination of swallowing. Conclusions: The model obtained can improve and/or complement the evaluation process carried out in patients with dysphagia of functional causes, neurological and neuromuscular diseases, in screening and diagnostic characterization processes.
How to cite this article: Suárez Escudero Juan Camilo, González Franco Sara, Franco Sánchez Isabela, Gómez Ríos Elizabeth, Martínez Moreno Lillyana. Model based on clinical characteristics to identify patients with neurogenic oropharyngeal dysphagia. Revista Cuidarte. 2024;15(3):e3861. https://doi.org/10.15649/cuidarte.3861
References
Warnecke T, Labeit B, Schroeder J, Reckels A, Ahring S, Lapa S, et al. Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System. Neurology. 2021;96(6):e876-e889. https://dx.doi.org/10.1212/WNL.0000000000011350
Giraldo-Cadavid LF, Gutiérrez-Achury AM, Ruales-Suárez K, Rengifo-Varona ML, Barros C, Posada A, et al. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study. Dysphagia.2016;31(3):398-406. https://dx.doi.org/10.1007/s00455-016-9690-1
Suárez-Escudero JC, Lema Porto KS, Palacio Patiño D, Izquierdo Moreno M, Bedoya Londoño CL. Disfagia orofaríngea neurogénica: concepto, fisiopatología, clínica y terapéutica. Arch Neuroci. 2022;27(4):44-56. https://dx.doi.org/10.31157/an.v27i4.347
López-Liria R, Fernández-Alonso M, Vega-Ramírez FA, Salido-Campos MÁ, Padilla-Góngora D. Treatment and rehabilitation of dysphagia following cerebrovascular disease. Rev Neurol. 2014;58(6):259–67. https://dx.doi.org/10.33588/rn.5806.2013335
Zambran-Toledo N. Maintenance of logopedic orientation in a patient with oropharyngeal dysphagia of neurogenic origin. Rev Neurol. 2001;32(10):986–9. https://dx.doi.org/10.33588/rn.3210.2000184
Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784-9.https://dx.doi.org/10.1001/archoto.2010.129
Cook IJ. Diagnostic evaluation of dysphagia. Nat Clin Pract Gastroenterol Hepatol. 2008;5(7):393-403. https://dx.doi.org/10.1038/ncpgasthep1153
Otolaryngol Clin North Am. Altman KW, Richards A, Goldberg L, Frucht S, McCabe DJ. Dysphagia in stroke, neurodegenerative disease, and advanced dementia. Otolaryngol Clin North Am. 2013;46(6):1137-49. https://dx.doi.org/10.1016/j.otc.2013.08.005
Ney DM, Weiss JM, Kind AJH, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24(3):395-413. https://dx.doi.org/10.1177/0884533609332005
Clavé P, Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig. 2004;96(2):119-31.https://dx.doi.org/10.4321/s1130-01082004000200005
Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49-59. https://dx.doi.org/10.1038/nrgastro.2015.199
Duncan S, Gaughey JM, Fallis R, McAuley DF, Walshe M, Blackwood B. Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis. Syst Rev. 2019;8(1):283.https://dx.doi.org/10.1186/s13643-019-1196-0
Gallegos C, Brito-de la Fuente E, Clavé P, Costa A, Assegehegn G. Nutritional Aspects of Dysphagia Management. Adv Food Nutr Res. 2017:81:271-318. https://dx.doi.org/10.1016/bs.afnr.2016.11.008
Daniels SK, Foundas AL, Iglesia GC, Sullivan MA. Lesion site in unilateral stroke patients with dysphagia. J Stroke Cerebrovasc Dis. 1996;6(1):30-4. https://dx.doi.org/10.1016/s1052-3057(96)80023-1
Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455-78. https://dx.doi.org/10.1016/s0016-5085(99)70144-7
Aydogdu I, Kiylioglu N, Tarlaci S, Tanriverdi Z, Alpaydin S, Acarer A, et al. Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17 years of experience in 1278 adults. Clin Neurophysiol. 2015;126(3):634-43. https://dx.doi.org/10.1016/j.clinph.2014.06.035
Terré R, Orient-López F, Guevara-Espinosa D, Ramón-Rona S, Bernabeu M, Clavé-Civit P. Disfagia orofaríngea en pacientes afectados de esclerosis múltiple. Rev Neurol. 2004;39(8):707–10. https://dx.doi.org/10.33588/rn.3908.2004247
Clavé P, Verdaguer A, Arreola V. Oral-pharyngeal dysphagia in the elderly. Med Clin (Barc). 2005;124(19):742-8. https://dx.doi.org/10.1157/13075447
Panebianco M, Marchese-Ragona R, Masiero S, Restivo DA. Dysphagia in neurological diseases: a literature review. Neurol Sci. 2020;41(11):3067-3073. https://dx.doi.org/10.1007/s10072-020-04495-2
Carnaby-Mann G, Lenius K. The bedside examination in dysphagia. Phys Med Rehabil Clin N Am. 2008;19(4):747-68. https://dx.doi.org/10.1016/j.pmr.2008.05.008
González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: an Overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-196. https://dx.doi.org/10.1007/s40141-013-0017-y
De Ruyck K, Duprez F, Werbrouck J, Sabbe N, Sofie DL, Boterberg T, et al. A predictive model for dysphagia following IMRT for head and neck cancer: introduction of the EMLasso technique. Radiother Oncol. 2013;107(3):295-9. https://dx.doi.org/10.1016/j.radonc.2013.03.021
Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23(1):59-64. https://dx.doi.org/10.1007/s00455-007-9097-0
Heijnen BJ, Böhringer S, Speyer R. Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation. Eur Arch Otorhinolaryngol. 2020;277(1):197-205. https://dx.doi.org/10.1007/s00405-019-05687-z
Xi X, Li H, Wang L, Yin X, Zeng J, Song Y, et al. How demographic and clinical characteristics contribute to the recovery of post-stroke dysphagia? Medicine (Baltimore). 2021;100(4):e24477. https://dx.doi.org/10.1097/MD.0000000000024477
Suárez Escudero JC, González Frnaco S, Franco Sánchez I, Gómez Ríos E, Martínez Moreno L. Base de datos clínica casos controles DON. MedSwallowDB: Gitlab 2024. https://gitlab.com/sroldanvasco/medswallowdb/-/blob/main/Base_datos_clinica_casos_controles_DON.xlsx?ref_type=heads
Suárez-Escudero JC, Martínez-Moreno L, Gómez-Ríos E, Rueda-Vallejo ZV. Percepción temporal de síntomas de disfagia en una cohorte de pacientes con disfagia orofaríngea neurogénica. Salud UIS. 2023;55:e23041. https://doi.org/10.18273/saluduis.55.e:23041
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665-71. https://dx.doi.org/10.1056/NEJM200103013440908
Oliveira DL, Moreira E a. M, de Freitas MB, Gonçalves J de A, Furkim AM, Clavé P. Pharyngeal Residue and Aspiration and the Relationship with Clinical/Nutritional Status of Patients with Oropharyngeal Dysphagia Submitted to Videofluoroscopy. J Nutr Health Aging. 2017;21(3):336-341.https://dx.doi.org/10.1007/s12603-016-0754-6
Lobo PP, Pinto S, Rocha L, Reimão S, de Carvalho M. Orofacial apraxia in motor neuron disease. Case Rep Neurol. 2013;5(1):47-51.https://dx.doi.org/10.1159/000349895
Steinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40(5):1903-6. https://dx.doi.org/10.1161/STROKEAHA.108.535468
Shaker R. Oropharyngeal Dysphagia. Gastroenterol Hepatol (NY). 2006;2(9):633-634.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350575/
Nazarko L. The management of dysphagia in palliative care. Int J Palliat Nurs. 2017;23(4):162-164. https://dx.doi.org/10.12968/ijpn.2017.23.4.162
Leslie P, Carding PN, Wilson JA. Investigation and management of chronic dysphagia. BMJ. 2003;326(7386):433-6.https://dx.doi.org/10.1136/bmj.326.7386.433
Verin E, Maltete D, Ouahchi Y, Marie JP, Hannequin D, Massardier EG, et al. Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: A pilot study. Ann Phys Rehabil Med. 2011;54(6):366-75. https://dx.doi.org/10.1016/j.rehab.2011.07.003
Clavé P, de Kraa M, Arreola V, Girvent M, Farré R, Palomera E, et al. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385-94. https://dx.doi.org/10.1111/j.1365-2036.2006.03118.x
Downloads
Published
How to Cite
Issue
Section
Categories
Funding data
-
Ministerio de Ciencia, Tecnología e Innovación
Grant numbers Código 121077758144 y número de contrato 825-2017
Altmetrics
Downloads
License
Copyright (c) 2024 Revista Cuidarte
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.