Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia.
Luis F Giraldo-Cadavid, Diego Insignares, Valentina Velasco and 4 others
PMID 38958706WHAT IT FOUND
Aspiration seen on swallowing endoscopy (FEES) was independently linked to pneumonia in patients at risk of dysphagia.
Penetration and residue were associated only when aspiration was also present, so aspiration is the key finding for pneumonia risk.
Key findings
01In 148 patients followed for a mean of 5.5 years, aspiration on FEES was independently associated with pneumonia, with an adjusted incidence of 26.6 cases of pneumonia per 100 people-years and a 7.25 times increased risk after adjustment.
02Penetration and residue were associated with pneumonia in models that did not adjust for aspiration, with risk increased by 7.85 and 6.24 times, but those associations disappeared after aspiration was added to the models.
03Among the 148 patients, 49 had at least one pneumonia and 105 pneumonia episodes occurred; aspiration was seen in 76 patients, penetration in 98, and residue in 107.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a cohort study, so it can show association but cannot prove that FEES findings caused pneumonia. The pneumonia diagnosis relied on clinical signs and chest radiograph findings, which are not highly specific or sensitive. The study did not check whether different examiners would record the same FEES findings, although it referred to earlier reliability work. Patients with mechanical dysphagia, active cancer, chemotherapy, pregnancy, or asplenia were excluded, so the results do not address those groups. Follow-up included a retrospective phase before FEES, and the exposed group was defined by FEES abnormalities, which can affect selection and timing of exposure. It was conducted in an outpatient rehabilitation service at a university hospital, so it may not apply to other settings.
The easy way to misread this
Do not conclude that penetration or residue alone cause pneumonia. In this cohort, their associations with pneumonia disappeared once aspiration was included in the models, and a cohort study cannot prove that any FEES finding caused pneumonia.