Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.
Eur Geriatr Med. 2022 Oct;13(5):1071-1080. doi: 10.1007/s41999-022-00689-3. Epub 2022 Aug 25.
Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions.
We performed a literature search in MEDLINE, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for "aspiration pneumonia" and "aged" were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission.
A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP.
There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients' general frailty rather than in relation to swallowing function itself.
社区获得性肺炎（CAP）在全球范围内非常常见。据报道，90%以上的老年人 CAP 可能是由于吸入引起的。然而，对于吸入性肺炎（AP）的诊断标准尚未广泛达成共识。是否有关于如何诊断 AP 的共识？被诊断为 AP 的患者的临床特征是什么？我们进行了一项系统评价来回答这些问题。
我们在 MEDLINE、EMBASE、CINHAL 和 Cochrane 中进行了文献检索，以综述诊断 AP 所采取的步骤。使用了“吸入性肺炎”和“老年”的检索词。纳入标准为：原始研究、社区获得性 AP、年龄≥75 岁、急性住院。
共发现 10716 份报告。去除重复项后，筛选了 7601 份，对 95 份进行了全文审查，最终有 9 份报告纳入了分析。大多数研究中，肺炎是通过症状、炎症标志物和胸部影像学发现的组合来诊断的。AP 被定义为与吸入或吞咽困难有关的肺炎。如果有目击或先前假定的吸入、食物或液体上咳嗽、相关基础疾病、透视或水吞咽试验异常以及胸部影像学上阴影的重力依赖性分布，则推断为吸入。与非 AP 患者相比，AP 患者年龄更大、身体更脆弱且合并症更多。
对于诊断 AP 的临床标准有广泛的共识。这是一种基于患者一般脆弱性的推测性诊断，而不是与吞咽功能本身有关。
