Early Screening Parameters for Dysphagia in Acute Ischemic Stroke

Abstract

Background: Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke. Methods: Our analysis was based on data from a prospective in-hospital registry. Patients with ischemic stroke were included over the course of 3 years. Patients were scheduled to undergo a clinical swallowing investigation within the first 24 h after hospital admission. Step-wise multivariate logistic regression was used to identify independent predictors of dysphagia in general and of pneumonia in particular. Results: 1,646 patients with ischemic stroke were included. Stroke severity in terms of higher National Institute of Health Stroke Scale (NIHSS) values (p < 0.001), male gender (p = 0.006) and higher age (p < 0.001) independently predicted dysphagia. A receiver operating characteristics analysis revealed an NIHSS cut-off value of 4.5 for optimal differentiation between patients with and without dysphagia (sensitivity 0.77; specificity 0.77). Dysphagia (p < 0.001), male gender (p = 0.002), higher NIHSS scores (p < 0.001) and higher age (p = 0.002) were factors that were independently associated with pneumonia. The NIHSS cut-off value for differentiating between patients with and without pneumonia was 5.5 (sensitivity 0.91; specificity 0.67). Conclusions: Stroke severity in terms of NIHSS is a simple and reliable predictor of dysphagia. Patients with NIHSS values ≥5 should be quickly directed towards a professional swallowing examination. Dysphagia was confirmed to be a strong predictor of pneumonia.

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

“…Moreover, in the study of Okubo et al [16], no patient with vertebrobasilar stroke was found to be dysphagic, which may have contributed to the higher cut-off value in relation to our findings. The cut-off of ≥5 that Henke et al [18] calculated in an unselected stroke population, that is, including infra-and supratentorial stroke cases, is comparatively low, especially considering that they also used clinical swallowing evaluation. A possible explanation is that the authors also included patients with prior strokes and possibly pre-existing dysphagia [18].…”

“…The cut-off of ≥5 that Henke et al [18] calculated in an unselected stroke population, that is, including infra-and supratentorial stroke cases, is comparatively low, especially considering that they also used clinical swallowing evaluation. A possible explanation is that the authors also included patients with prior strokes and possibly pre-existing dysphagia [18]. Moreover, patients with haemorrhagic strokes were excluded, a group with generally higher NIH-SS scores [18] and higher risk of severe, persistent dysphagia [15].…”

“…A possible explanation is that the authors also included patients with prior strokes and possibly pre-existing dysphagia [18]. Moreover, patients with haemorrhagic strokes were excluded, a group with generally higher NIH-SS scores [18] and higher risk of severe, persistent dysphagia [15]. Jeyaseelan et al [14] used instrumental methods in some of their patients to investigate swallowing function.…”

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

“…Neurologic disorders such as stroke can cause dysphagia, which may occur in 37%–55% of stroke patients . Stroke severity as assessed by the National Institutes of Health Stroke Scale; ≥5 is a reliable predictor of dysphagia . Severity of dysphagia may vary according to the region affected by the stroke.…”

“…When swallowing becomes inefficient, uncomfortable, or is deemed unsafe, additional care and consideration regarding OI and the many factors related to this change must occur. Dysphagia is a swallowing disorder that impacts oral, pharyngeal, and/or esophageal function because of anatomic or physiological insult . Repercussions of dysphagia can impact quality of life (QoL), hydration, nutrition, and medication administration, and there may be increased risk for or an association with further medical complications.…”