Validation of the Fiberoptic Endoscopy Evaluation of Swallowing in Aspiration Pneumonia: Utility of the Hyodo Dysphagia Score in Predicting the Development of Aspiration Pneumonia

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation Pub Date : 2025-06-01 DOI:10.1016/j.arrct.2025.100435

Yoko Ibe MD, PhD , Masayuki Tazawa MD, PhD , Hironori Arii MD, PhD , Yumiko Nakao MD, PhD , Risa Toyama MD , Naoki Wada MD, PhD

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Abstract

Objective

To analyze the characteristics of flexible endoscopic evaluation of swallowing (FEES) findings in patients with aspiration pneumonia using the Hyodo dysphagia score and to evaluate the risk of aspiration pneumonia.

Design

Retrospective study.

Setting

Observation in a single primary care institution.

Participants

Inpatients aged ≥20 years who underwent FEES in our hospital between April 2012 and March 2022. A total of 178 patients were eligible to calculate the Hyodo dysphagia score and were enrolled in this study. The mean ± SD age of the subjects was 73.4±13.3 years, and 116 of 178 patients (65.2%) were men.

Intervention

Not applicable.

Main Outcome Measures

The development of aspiration pneumonia.

Results

Eighty-four of 178 patients (47.2%) developed aspiration pneumonia. Age, oral intake status, and serum albumin levels were not significantly different between the pneumonia and nonpneumonia groups. The total and each parameter of the Hyodo dysphagia score were significantly higher in the pneumonia group than in the nonpneumonia group. Logistic regression analysis showed that salivary retention (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.09-1.33; P=.016) and poor cough reflex (OR, 1.88; 95% CI, 1.42-2.49; P<.001) in the Hyodo dysphagia score were risk factors for aspiration pneumonia. The area under the curve of the receiver operating characteristic curve for the onset of pneumonia based on the total Hyodo dysphagia score was 0.75 (95% CI, 0.67-0.82). A cutoff value of 5 for the total Hyodo dysphagia score gave a sensitivity of 0.75 (95% CI, 0.67-0.83) and a specificity of 0.60 (95% CI, 0.49-0.71), with the Youden index having a maximum value of 0.35.

Conclusions

A cutoff value of 5 points for the total Hyodo dysphagia score was optimal in predicting the development of aspiration pneumonia. Salivary retention and poor cough reflex were risk factors for the development of pneumonia.

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纤维内窥镜对吸入性肺炎吞咽评估的验证：Hyodo吞咽困难评分在预测吸入性肺炎发展中的应用

目的应用Hyodo吞咽困难评分分析吸入性肺炎患者柔性内镜吞咽检查（FEES）的特点，评价吸入性肺炎的发生风险。DesignRetrospective研究。在单一的初级保健机构观察。参与者为2012年4月至2022年3月期间在我院接受FEES治疗的年龄≥20岁的患者。共有178名患者符合计算Hyodo吞咽困难评分的条件，并被纳入本研究。受试者的平均±SD年龄为73.4±13.3岁，178例患者中116例（65.2%）为男性。InterventionNot适用。主要观察指标吸入性肺炎的发生。结果178例患者中84例（47.2%）发生吸入性肺炎。肺炎组和非肺炎组的年龄、口服摄入状况和血清白蛋白水平无显著差异。肺炎组Hyodo吞咽困难总分及各项指标均显著高于非肺炎组。Logistic回归分析显示，唾液潴留(优势比[OR]， 1.60；95%置信区间[CI]， 1.09-1.33；P= 0.016)和咳嗽反射差(OR, 1.88；95% ci, 1.42-2.49；（p < 0.01）是吸入性肺炎的危险因素。基于总Hyodo吞咽困难评分的肺炎发病的受试者工作特征曲线曲线下面积为0.75 （95% CI, 0.67-0.82）。Hyodo吞咽困难总分的临界值为5，灵敏度为0.75 (95% CI, 0.67-0.83)，特异性为0.60 (95% CI, 0.49-0.71)，约登指数的最大值为0.35。结论Hyodo吞咽困难总分5分是预测吸入性肺炎发生的最佳临界值。唾液潴留和咳嗽反射差是发生肺炎的危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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