Long-term outcome after stroke: does dysphagia matter? (original) (raw)
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Dysphagia is a strong predictor of death and functional dependence at three months post-stroke
Arquivos de neuro-psiquiatria, 2022
BACKGROUND Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. OBJECTIVE To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. METHODS Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure. RESULTS A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13...
Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome
PloS one, 2016
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....
Predictors of prolonged dysphagia following acute stroke
Journal of Clinical Neuroscience, 2003
Dysphagia following acute stroke frequently necessitates prolonged enteral feeding. There is evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. The aim of this study was to identify predictors of prolonged dysphagia. The subjects were 149 consecutive patients admitted with acute stroke. Clinical findings and imaging results were prospectively collected, and subsequent progress recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (O14 days); or prolonged dysphagia (>14 days). Validity of the water swallow test as a predictor of aspiration pneumonia was confirmed. Significant associations for prolonged dysphagia were seen with stroke severity, dysphasia and lesions of the frontal and insular cortex on brain imaging. These results indicate that it may be possible to predict patients who will develop prolonged significant dysphagia following acute stroke thereby facilitating referral for insertion of PEG at an earlier time point. ª
Post-stroke dysphagia: frequency, risk factors, and topographic representation: hospital-based study
2021
Background The frequency of dysphagia varies considerably across literature. Post-stroke dysphagia is a common cause of increased morbidity and length of hospitalization. This study aimed to estimate the frequency, risk factors of dysphagia following first-ever ischemic or hemorrhagic stroke and its neuroradiological correlation. Methods Two hundred fifty patients (180 ischemic and 70 hemorrhagic strokes) with first-ever stroke were recruited within 72 h of onset. Detailed history, neurological examination, and computed tomography and/or magnetic resonance were done for each patient. Severity of stroke was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Swallowing function was assessed by water swallowing test (WST) and dysphagia outcome severity scale (DOSS). Results Ninety-eight (39.2%) of all stroke patients had dysphagia, 57 (31.7%) of ischemic group, 41 (58.6%) of hemorrhagic group. The mean age of ischemic group with dysphagia was older than ages of non-dy...
Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management
International Journal of Phonosurgery & Laryngology, 2021
Original research language pathologist in which various maneuvers could be elicited on patients to assess which method would be more helpful in improving their symptom. During FEES, we closely monitored SPO 2 (oxygen saturation) of our patients. The three scales considered were penetration aspiration scale, secretion rating scale, and residue rating scale. According to the severity of score, patients were given compensatory and rehabilitative swallowing therapy. • Stroke severity was assessed by NIHSS score. • Location of stroke was done on the basis of computed tomography (CT) scan of the brain. The primary aim of our study was to assess the incidence of dysphagia in acute stroke patients and analyze the benefits of early screening and management. Statistical Analysis Data were expressed as number (%) and compared using Wilcoxon signed-rank test. The two groups (patients with dysphagia vs • Fiber-optic endoscopic evaluation of swallowing (FEES): 3 We performed this procedure along with our speech and
Neurology India, 2008
infection, nutritional problems and dehydration. [15,16] Patients with dysphagia are more likely to require care in rehabilitation centers. [17] Dysphagia is also an independent predictor of respiratory morbidity and mortality in acute stroke. [18,19] In this prospective study, the aim was to correlate the presence of dysphagia following stroke with the vascular territory involved along with volume of infarct/ hemorrhage. The aim was also to determine morbidity and mortality in patients having dysphagia following stroke and to determine the predictive value of individual parameters in the Standardized Swallowing Assessment [20] {SSA} (Annex. 1), (a bedside test used for assessing dysphagia) for prediction of chest infection. We also aimed to determine the value of dysphagia for predicting respiratory morbidity and subsequent mortality in acute stroke. Materials and Methods The study was carried out in a tertiary care teaching hospital. Fifty patients, admitted within 48 h of acute stroke were serially recruited. Patients with glasgow coma score (GCS) less than 10, poor postural control (thus unable to sit up for SSA) and patients presenting after 48 h of onset were not included. Standard clinical neurological examination and imaging were performed and patients were classified according to Oxfordshire Community Stroke Project (OCSP) clinical classification in the case of infarcts. [21] The SSA was carried out in all patients within 24 h of admission. Pulse oximetry (MICROMON 7142L) (Annex.2) was performed simultaneously with Stage 2 and 3 of SSA. Patients with desaturation ≥ 2% from Aims: The study aimed at correlation of post-stroke dysphagia with area and volume of infarct/ bleed, and with subsequent in-hospital respiratory morbidity and mortality. Materials and Methods: 50 patients of acute stroke were serially recruited. Standard Staff swallowing assessment was performed within 24 hours of admission along with pulse oximetry. Ischemic strokes were classified as per OCPS registry. In-hospital respiratory morbidity and mortality, mode of nutrition and disability status at discharge were noted. Results: 21/50 (42%) patients had post-stroke dysphagia during their hospital course. Among infarcts, Total Anterior Circulation Infarcts (TACI) had 100% incidence of dysphagia, followed by Partial Anterior Circulation Infarcts (PACI-36%), Posterior Circulation infarcts (POCI-33%), and Lacunar infarcts (LACI-18%). 67% of hemorrhages had post-stroke dysphagia. Staff swallowing assessment had a sensitivity and specificity of 75% and 73% respy., for predicting respiratory morbidity. The corresponding figures for Pulse oximetry were 79% and 91%.
Geriatrics
The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management ...
The Effects of Dysphagia on Quality of Life in Stroke Survivors
Middle East Journal of Rehabilitation and Health Studies
Background: Oropharyngeal dysphagia is a common problem in stroke survivors. Dysphagia and its complications have negative effects on quality of life in stroke survivors. Objectives: This study aimed to investigate the impacts of dysphagia on quality of life in Iranian stroke survivors and to determine potential relationships between demographic variables and the domains of quality of life. Methods: Sixty stroke survivors (aged 60 - 75 years old) with a diagnosis of dysphagia participated in this cross-sectional study. The swallowing function of patients was evaluated by Mann Assessment Swallowing Ability (MASA). The Persian version of the Dysphagia Handicap Index (DHI) was used to determine the impacts of swallowing disorder on the quality of life. Results: The mean total and SD of DHI was 73.03 ± 10.16. There was no statistically significant relationship between sex; age, time post-onset of stroke, and DHI total score as well as its subscales (P > 0.05), whereas there was a rel...
Dysphagia after stroke: an overview
Current Physical Medicine and Rehabilitation Reports, 2013
Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.
Dysphagia Related Health Consequences among Patients with Acute Stroke in Cairo, Egypt
The Medical Journal of Cairo University, 2018
Background: Dysphagia is a common complication of stroke; it places the patient with acute stroke at risk for poor nutrition and dehydration. In addition to other dangerous complications as post stroke pneumonia. Aim of Study: To explore dysphagia related health consequences (post stroke pneumonia, length of ICU stay and death) among patients with acute stroke in Cairo, Egypt. Research Design: A descriptive exploratory research design was utilized. Research Question: What are the dysphagia related health consequences as indicated by post stroke pneumonia, length of ICU stay and death) among patients with acute stroke in Cairo, Egypt? Setting: The current study was carried out at a stroke unit affiliated to a selected hospital in Cairo, Egypt. Sample: A purposive sample consisting of 70 adult male and female patients with acute stroke. Tools of Data Collection: Three tools were used by the investigator to collect data pertinent to the study: Tool 1: Personal background and medical data, Tool 2: Gugging Swallowing Screen test (GUSS) Tool 3: Post stroke Pneumonia assessment tool. Results: 30% of the studied sample was in the age group of 61-70 years old, 54% of the study sample was female, and about half (45.7%) of the studied sample had a moderate degree of dyaphagia. 37.1% of the studied sample stayed from 5 to 7 days in the Intensive Care Unit. (7.1%) of the studied sample had died. More than half (57.1%) of the studied sample didn't develop post stroke pneumonia. There was a significant statistical relationship between degree of dysphagia and (post stroke pneumonia, death and length of ICU stay). Conclusion: Dysphagia following the acute stroke is very important issue to be considered during handling, caring and management of patients with it. Recommendation: Replication of this study on a representative sample for such group of patients all over the Arab