Community Acquired Pneumonia in Older Adults

NCT ID: NCT04709978

Last Updated: 2023-11-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

75 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-02-24

Study Completion Date

2023-07-02

Brief Summary

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This study will utilize diagnostic imaging and salivary biomarkers to estimate the prevalence of aspiration in older adults with suspected community-acquired bacterial pneumonia (CABP). 150 participants over the age of 60 diagnosed with pneumonia will be recruited into this study. 62 of these participants will be enrolled in a supplemental study.

Detailed Description

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Pneumonia is the most common infectious cause of mortality in older adults. Standard practice for older adults with pneumonia involves hospitalization and antibiotics. However, recent studies suggest that a significant portion of suspected community-acquired bacterial pneumonia (CABP) cases may actually be due to distinct, dysphagia-related aspiration syndromes (e.g. aspiration pneumonia, pneumonitis).

The main study will will assess whether salivary biomarkers (viscoelasticity, substance P) and swallowing function tests can be used to help differentiate CABP from aspiration-related syndromes. The following aims will be completed:

* Aim 1: Compare salivary properties and health outcomes among older adults with aspiration related pneumonia mimics and those with infectious pneumonia
* Aim 2: Compare appearance of lung ultrasound findings among older adults with aspiration related pneumonia mimics and those with infectious pneumonia.
* Aim 3: Describe dysphagia screening results, patient reported swallowing function, salivary properties, oral/nasopharyngeal microbiome profiles, in older adults with pneumonia presenting to the ED.
* Aim 4: Assess the potential impact of the MeMed BV® test's result on patient management decision making, including antibiotic prescribing and disposition.

A supplemental study will be the first to utilize diagnostic imaging (videofluoroscopic evaluation of swallowing and radionuclide salivagram) to estimate the prevalence of aspiration in older adults with suspected CABP.

* Aim 1: Determine the prevalence of dysphagia-related aspiration among older adults with pneumonia.

Conditions

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Pneumonia Aspiration Pneumonia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Pneumonia

Participants will be over the age of 60 and diagnosed with pneumonia in the UW Emergency Department or treated for pneumonia in the past 6 months.

Videofluoroscopic Swallowing Study

Intervention Type DIAGNOSTIC_TEST

Participants enrolled in supplemental study will swallow different barium containing liquid and food boluses types that are captured on fluoroscopic imaging in real time.

Nuclear medicine pulmonary aspiration study

Intervention Type DIAGNOSTIC_TEST

Participants enrolled in supplemental study will be administered radiotracer (Tc-99m-Sulfur Colloid) orally and static images of the chest will then be obtained at specified intervals over the next 2 hours to determine location of the radiotracer.

TOR-BSST and 3 oz Water Swallow

Intervention Type DIAGNOSTIC_TEST

The research specialist will conduct ten 1 tsp water swallows, one cup sip of water and a 3 ounce water swallow test with the patient. After each swallow, the participant is asked to say "ah" so that their voice quality can be assessed.

Sputum Culture

Intervention Type DIAGNOSTIC_TEST

Patients will have sputum collected during stay (ED participants only)

MeMed BV®

Intervention Type DIAGNOSTIC_TEST

A blood test to help determine if the infection is viral or bacterial (ED participants only)

Lung Ultrasound

Intervention Type DIAGNOSTIC_TEST

To image the lungs (ED participants only)

Respiratory Function Tests

Intervention Type DIAGNOSTIC_TEST

To measure respiratory pressures.

Interventions

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Videofluoroscopic Swallowing Study

Participants enrolled in supplemental study will swallow different barium containing liquid and food boluses types that are captured on fluoroscopic imaging in real time.

Intervention Type DIAGNOSTIC_TEST

Nuclear medicine pulmonary aspiration study

Participants enrolled in supplemental study will be administered radiotracer (Tc-99m-Sulfur Colloid) orally and static images of the chest will then be obtained at specified intervals over the next 2 hours to determine location of the radiotracer.

Intervention Type DIAGNOSTIC_TEST

TOR-BSST and 3 oz Water Swallow

The research specialist will conduct ten 1 tsp water swallows, one cup sip of water and a 3 ounce water swallow test with the patient. After each swallow, the participant is asked to say "ah" so that their voice quality can be assessed.

Intervention Type DIAGNOSTIC_TEST

Sputum Culture

Patients will have sputum collected during stay (ED participants only)

Intervention Type DIAGNOSTIC_TEST

MeMed BV®

A blood test to help determine if the infection is viral or bacterial (ED participants only)

Intervention Type DIAGNOSTIC_TEST

Lung Ultrasound

To image the lungs (ED participants only)

Intervention Type DIAGNOSTIC_TEST

Respiratory Function Tests

To measure respiratory pressures.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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bedside dysphagia screening; 3 ounce water swallow test manometer peak cough flow

Eligibility Criteria

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Inclusion Criteria

* 60 years of age or older
* Patient has clinical criteria for pneumonia or is being treated for pneumonia as defined by abnormal chest imaging or receiving antibiotics for a chest infection or the provider thinks the patient has pneumonia or is planning to treat the patient for pneumonia.
* Patient is clinically stable and able to safely drink water, per the emergency department provider
* Ability to provide consent or the presence of a legally authorized representative (LAR) who can consent on behalf of the patient


* 60 years of age and older
* Patient was diagnosed with or treated for pneumonia at UW Health in the past 6 months
* Ability to provide consent or the presence of a legally authorized representative (LAR) who can consent on behalf of the patient

Exclusion Criteria

* Prisoner
* Non-English speaking
* Respiratory symptoms for 7 days or more

Phone Recruitment


* Prisoner
* Non-English speaking
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Gordon and Betty Moore Foundation

OTHER

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Michael Pulia, MD, MS

Role: PRINCIPAL_INVESTIGATOR

University of Wisconsin, Madison

Locations

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University of Wisconsin

Madison, Wisconsin, United States

Site Status

Countries

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United States

Other Identifiers

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Protocol Version 11/3/22

Identifier Type: OTHER

Identifier Source: secondary_id

A534100

Identifier Type: OTHER

Identifier Source: secondary_id

SMPH/EMERG MED

Identifier Type: OTHER

Identifier Source: secondary_id

A534255

Identifier Type: OTHER

Identifier Source: secondary_id

2020-1121

Identifier Type: -

Identifier Source: org_study_id

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