Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis

Abstract

Background Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. Methods Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. Results The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. Conclusions Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. Trial registration https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb.

Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Stroke, also referred to as a cerebrovascular accident, is a common and debilitating disease with a high prevalence of disability and fatality [ 1 ]. Post-stroke dysphagia (PSD), which is defined as difficulty swallowing after stroke, is one of the most common complications, affecting nearly half of stroke survivors [ 2 ]. PSD is associated with various devastating consequences, including malnutrition, water–electrolyte imbalance, aspiration, pneumonia, prolonged length of hospital stay, psychological distress, reduced quality of life, and increased risk of mortality [ 2 , 3 ].…”

“…Post-stroke dysphagia (PSD), which is defined as difficulty swallowing after stroke, is one of the most common complications, affecting nearly half of stroke survivors [ 2 ]. PSD is associated with various devastating consequences, including malnutrition, water–electrolyte imbalance, aspiration, pneumonia, prolonged length of hospital stay, psychological distress, reduced quality of life, and increased risk of mortality [ 2 , 3 ]. Over the past two decades, the area of neuroplasticity has become increasingly popular, especially the mechanism of swallowing function with the immense complexity of neural circuits is supposed to respond considerably to rehabilitative treatment [ 4 , 5 ].…”

Development of Two Patient Self-Reported Measures on Functional Health Status (FOD) and Health-Related Quality of Life (QOD) in Adults with Oropharyngeal Dysphagia Using the Delphi Technique

“…Problems in swallowing or oropharyngeal dysphagia (OD) is associated with high morbidity and mortality rates [ 1 ]. OD can lead to dehydration, malnutrition and even death, and may have a major impact on a patient’s health-related quality of life and well-being [ 2 ].…”

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

“…Indeed, poststroke dysphagia is associated with increased risk of pneumonia and mortality [2 ▪▪ ], while presence and severity of dysphagia in Parkinson's disease patients are negative prognostic factors [3 ▪ ,4 ▪ ]. Of note, the assessment method influences the identification rates of dysphagia, since – for example – dysphagia prevalence in stroke patients ranges from 38% when diagnosed by the clinical swallow examination to 75% when obtained via instrumental techniques [2 ▪▪ ]. The adoption of validated tools is also important, as suggested by evidence on poststroke dysphagia [2 ▪▪ ].…”

“…Of note, the assessment method influences the identification rates of dysphagia, since – for example – dysphagia prevalence in stroke patients ranges from 38% when diagnosed by the clinical swallow examination to 75% when obtained via instrumental techniques [2 ▪▪ ]. The adoption of validated tools is also important, as suggested by evidence on poststroke dysphagia [2 ▪▪ ]. With regard to Parkinson's disease, prevalence of esophageal and oropharyngeal dysphagia is as high as 40 and 80%, respectively [5,6].…”