{
  "abstract": "Introduction Poststroke dysphagia and impaired cough reflex contribute to aspiration and pneumonia, yet the clinical value of cough reflex testing remains unclear.Patients and methods In this prospective observational study, 395 patients who had an acute stroke admitted to an intensive care unit underwent fiberoptic endoscopic evaluation of swallowing and citric acid cough reflex testing at 0.4 mol/L. Dysphagia severity was rated using the Fiberoptic Endoscopic Dysphagia Severity Scale, with additional measures of secretion management, airway invasion and oral intake. Accuracy of cough reflex testing was calculated against fiberoptic endoscopic evaluation of swallowing. Ordinal and binary logistic regression assessed associations between cough reflex, dysphagia severity, pneumonia and mortality, including interactions.Results Cough reflex testing showed 75% sensitivity and 55% specificity for silent aspiration and 78% sensitivity and 43% specificity for any aspiration. Absent or weakened cough reflex predicted severe dysphagia, impaired secretion management, increased aspiration risk, restricted oral intake and reduced spontaneous swallowing (p<0.001). Older age, stroke severity, impaired cough reflex and dysphagia severity predicted mortality. Preserved cough reduced pneumonia risk only in mild dysphagia.Discussion Impaired cough reflex independently predicted poststroke dysphagia severity, impaired secretion management, aspiration risk, restricted oral intake and poorer functional outcome. Preserved cough conferred protection against pneumonia only in mild dysphagia, whereas in moderate to severe dysphagia aspiration burden and systemic vulnerability likely predominate, limiting clinical relevance of cough testing.Conclusion Cough reflex testing provides meaningful information on poststroke dysphagia severity and airway protection and may support risk stratification when instrumental swallowing assessment is unavailable.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany",
        "Department of Health, University Witten Herdecke Faculty of Health, Witten, Germany"
      ],
      "name": "Anne Jung"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany"
      ],
      "name": "Bendix Labeit"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Stephan Oelenberg"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Christina Wueller"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Sigrid Ahring"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Sonja Sauer"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Lisa-Marie Schulze Hillert"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Linda Hartwig"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Paul Muhle"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Anne Pilatus"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany"
      ],
      "name": "Tobias Warnecke"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany"
      ],
      "name": "Rainer Dziewas"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospital Münster, Münster, Germany"
      ],
      "name": "Sonja Suntrup-Krueger"
    }
  ],
  "title": "Cough reflex testing for dysphagia severity and pneumonia risk after acute stroke: a prospective observational study",
  "uid": "c9ef393a-96f9-5e07-936e-14566627eb4c"
}