1. Cleveland Clinic
Science Internship Program
A Retrospective Study of Patients Prescribed
Honey Thick Liquids on Pneumonia Incidence
Sunder Sai, Marianne Douglas, MS, CCC/SLP,
Carolyn Balogh, MA, CCC/SLP, Kelly Staruch, MA, CCC/SLP
Cleveland Clinic-Marymount Hospital
Hypothesis
Methodology
• The incidence of pneumonia in the population
receiving honey thick liquids does not exceed the
incidence in the general population of a regional
hospital
• 100 patients who were on honey thick liquids were
selected from medical records from the year 2010 to
July of 2012.
• Using EPIC each patient was identified for pneumonia
1-3 months cumulative, 3-6 months cumulative, and 6-
12 months cumulative after prescribed honey thick
liquids
 Diagnosis of pneumonia was diagnosed by the
physician and identified through medical records
• Urinary Tract Infection was tracked 6 months after
prescribed honey thick liquids
• Dehydration was tracked 12 months after prescribed
honey thick liquids
Data
Data
Conclusions
• No definitive conclusions can be made comparing sample
groups. The cumulative incidence of pneumonia at 3 months
cumulative for the honey thick liquid group was equal to the
general population group for the years 2010-2012 (5%)
• The cumulative incidence of pneumonia at 6 months was 1%
greater than the cumulative average pneumonia rate for the
years 2010-2012
• The cumulative incidence of pneumonia at 1 year was 4%
lower than the cumulative average pneumonia rate for the
years 2010-2012 (5%)
Recommendations
• Replicate the study with a larger sample size
• Repeat the study comparing patients on honey thick liquids
to another control group
• Narrow data collection for the pneumonia diagnosis from
general pneumonia to aspiration pneumonia
• Obtain data collection from subjects with similar medical
histories
• Analyze patient need for thickened liquids up to a year
following video swallow
• Examine UTI/Dehydration for further analysis
Introduction
• Pneumonia
 Pneumonia is one of the leading causes of
hospitalization and mortality in the United States
(Niederman, MS, Mandell, LA, Anzueto, A, et al, 2001)
 The most common cause of infectious death in
the U.S. among persons over age 65 (LaCroix,
Lipson, Miles, & White, 1989)
 It is the third leading cause of death for
persons over 85 (LaCroix, Lipson, Miles, & White,
1989)
 Pneumonia is the top ranked diagnoses at
Marymount hospital for the years 2010, 2011,
and 2012 (Marymount Data Analysis, 2012)
• Aspiration Pneumonia
 Infection in the bases of the lungs secondary to
weakness, lack of coordination, or decrease
sensation of the throat muscles common in
stroke
• Diagnosis of Dysphagia
 Dysphagia: difficulty/inability to swallow
safely/efficiently
 Video swallow tests are taken to see the
patient’s swallowing
 Patient swallows liquid barium while X-Ray
records images. This indicates if food/liquids
enter lungs
• Thicknesses of Liquids
 If aspiration is noted then a certain thickness of
liquid is prescribed
 The thickness of liquid in the diet is prescribed
to prevent further aspiration and ultimately
pneumonia
Study Aims
• Honey thick liquids are most commonly used to
prevent aspiration pneumonia (Groher & McKaig,
1995)
 There is little evidence to evaluate the
effectiveness of honey thick liquids
• The aim is to determine if the risk of pneumonia
for patients receiving honey thick liquids is equal
or less than the general population
Sample Size
• 100 randomized patients on honey thick liquids from
1/6/2010 – 6/2/2011 will be analyzed
 All underwent video swallow procedure
 All received honey thick liquids
• All patients are from an age range of 50-100 years
Pneumonia Rate per 100 of Honey Thick Liquids
5
1
6
999495
0
10
20
30
40
50
60
70
80
90
100
1-3 months 3-6 months 6-12 months
Time
NumberofPatients
Yes
No
Dehydration 12months
After
95%
5%
Yes
No
UTI 6months After
11%
89%
Yes
No
2011
5%
95%
2010 4%
96%
Yes
No
2012
6%
94%
Marymount
Hospital
Pneumonia
Rate
Limitations
• Physician’s diagnosis of pneumonia as indicated in the
medical records, not verified by X-Ray
• Patient’s compliance with honey thick liquids upon
discharge from hospital
• Patient necessity of honey thick liquids up to a year
following video swallow
• Research from medical records in the EPIC online
database
• Pneumonia diagnosis in the Marymount population
included general pneumonia cases and not specifically
aspiration pneumonia
• Varied medical histories across the study and control
groups
• A previous study cited pneumonia incidence of 20-40% in
elderly patients with stroke, dementia, or Parkinson's
disease, or residing in nursing homes (Robbins 2008).
• In the same study pneumonia incidence for patients on all
interventions (chin down, nectar, and honey) was 11% at
the 3 month cumulative interval (Robbins 2008).
• The cumulative 3 month incidence rate of pneumonia in
our honey thick liquid sample group was 5%, thus
significantly lower than the 11% noted in the previous
study
Conclusions