The Influence of Cough Reflex Testing on Patient Management.

Cough reflex testing (CRT) is an adjunct to the clinical swallowing evaluation (CSE), providing information on patients' risk of silent aspiration. CRT has been shown to influence diet recommendations, but in previous work, the many varied patient characteristics are not controlled. Therefore, the specific role of CRT results in these decisions remains unclear as this relationship has not been directly assessed. An online survey was sent to speech language therapists working in dysphagia. Two patient cases were presented that differed only by the presence of risk factors for the development of aspiration pneumonia. For each patient case, there were three assessment scenarios: CSE information only, CSE information with a "pass" CRT result, and CSE information with a "fail" CRT result. Clinicians outlined their patient management plans for each of the six scenarios. Ninety-seven data sets were used in the final analysis. A "fail" result was found to lead to the most restrictive patient management. Decisions made when provided with only CSE information were very similar to decisions made for a CSE with a "pass" result. Aspiration pneumonia risk factors were shown to influence decision making, with the low-risk patient more likely to be recommended a less restrictive diet. When information was available regarding silent aspiration risk, clinicians factored the results into their decision making. However, in the absence of a CRT result, airway sensation was assumed to be intact in the absence of information. This finding warrants further investigation given the impact this assumption may have on a patient's pulmonary health.