Journal Article

Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Arnold, Marcel, Sarikaya, Hakan, Mono, Marie-Luise, Jung, Simon, El-Koussy, Marwan, Kägi, Georg, Broeg-Morvay, Anne, Liesirova, Kai, Meisterernst, Julia, Schlager, Markus

2016

Overview

Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, p<0.001), stayed longer at monitored stroke unit beds (4.4±2.8 vs. 2.7±2.4 days; p<0.001) and were less often discharged to home (19.5% vs. 63.7%, p = 0.001) as compared to those without dysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; p<0.001), less often lived at home (38.8% vs. 76.5%; p<0.001), and more often had died (13.6% vs. 1.6%; p<0.001). Multivariate analyses identified dysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Aged, 80 and over / Biology and Life Sciences / Brain Ischemia - complications / Brain Ischemia - epidemiology / Care and treatment / Clinical outcomes / Comorbidity / Comparative analysis / Complications and side effects / Deglutition / Deglutition disorders / Deglutition Disorders - complications / Deglutition Disorders - epidemiology / Development and progression / Dysphagia / Enteral Nutrition / Female / Humans / Incidence / Intubation, Gastrointestinal - adverse effects / Ischemia / Length of Stay / Male / Medicine and Health Sciences / Middle Aged / Mortality / Neurology / Nosocomial infections / Patient Discharge / Patient outcomes / Patients / People and Places / Pneumonia / Pneumonia, Aspiration - complications / Prospective Studies / Risk factors / Stroke / Stroke - complications / Stroke - epidemiology / Swallowing / Thrombolytic Therapy / Treatment Outcome / Young Adult