Usefulness of Citric Cough Test for Screening of Silent Aspiration in Subacute Stroke Patients: A Prospective Study

Anna Guillén-Solà, Sandra Cecilia Chiarella, Juan Martínez-Orfila, Esther Duarte, Martha Alvarado-Panesso, Antoni Figueres-Cugat, Núria Bas, Ester Marco

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© 2015 American Congress of Rehabilitation Medicine. Abstract Objective To detect silent aspiration in a homogeneous sample of stroke patients using the citric acid cough test. Design Prospective study. Setting Public university tertiary hospital. Participants Consecutive subacute stroke patients (N=134; 74 men, 60 women; mean age ± SD, 62.2±11.9y; 11.7±9.9d after stroke) who had complained of dysphagic symptoms, referred for rehabilitation from December 2010 to October 2012. Intervention All patients were administered a citric acid cough test and underwent a videofluoroscopic swallowing study (VFSS). A reduced or an absent response on the citric acid cough test was considered when cough peaks were ≤4. A control group of healthy volunteers was also screened. Main Outcome Measures The citric acid cough test results were compared with the VFSS results, which were used as a criterion standard. Results There were 36 patients with a positive citric acid cough test, of which the VFSS revealed penetration in 14 cases (38.9%), aspiration in 5 (13.9%), silent aspiration in 5 (13.9%), and normality in 12 patients (33.3%). The sensitivity and specificity indexes for the reliability of citric acid cough test as a screening method for silent aspiration in comparison with the VFSS were.19 and.71, respectively. Other comparisons were made between silent aspirators (Penetration Aspiration Scale=8) and different subgroups of patients, but values remained poor. Conclusions The citric acid cough test using 1.0 (weight by volume)% for 1 minute does not seem to be a useful standalone tool to screen for silent aspiration in subacute stroke patients with suspected dysphagia.
Original languageEnglish
Article number56135
Pages (from-to)1277-1283
JournalArchives of Physical Medicine and Rehabilitation
Issue number7
Publication statusPublished - 1 Jan 2015


  • Cough
  • Deglutition disorders
  • Diagnosis
  • Rehabilitation
  • Respiratory aspiration


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