Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison

We sought to evaluate the efficacy of testing the laryngeal cough reflex in identifying pneumonia risk in acute stroke patients.

We performed a prospective study of 400 consecutive acute stroke patients examined using the reflex cough test (RCT) compared with 204 consecutive acute stroke patients from a sister facility examined without using the RCT. The binary end point for the study outcome was the development of pneumonia.

Of the 400 patients examined with the RCT, 5 developed pneumonia. Of the 204 patients examined without the RCT, 27 developed pneumonia (P<0.001). Three of the 27 patients died in the rehabilitation hospital of respiratory failure secondary to pneumonia. Seven others were transferred to the emergency department with acute respiratory distress. Power analysis for this comparison was 0.99. There were no other significant differences between the 2 groups.

A normal RCT after an acute stroke indicates a neurologically intact laryngeal cough reflex, a protected airway, and a low risk for developing aspiration pneumonia with oral feeding. An abnormal RCT indicates risk of an unprotected airway and an increased incidence of aspiration pneumonia. Alternate feeding strategies and preventive measures are necessary with an abnormal RCT. Clinical treatment algorithm and prescription of food, fluids, and medications are discussed on the basis of RCT results.