The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke

Flowers, Heather; Silver, Frank L.; Fang, Jiming; Rochon, Elizabeth; Martino, Rosemary

doi:10.1016/j.jcomdis.2013.04.001

Cited by 196 publications

(163 citation statements)

References 51 publications

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“…This may have led to a selection bias with a higher prevalence of dysphagia and could have led to a false high positive predictive value and a false low negative predictive value. However, the epidemiologic parameters suggest that we analysed a representative cohort, as demographic and stroke characteristics are consistent with other studies in this field [26,[31][32][33].…”

Section: Limitationssupporting

confidence: 84%

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

et al. 2018

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Background: For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter. Methods: During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS > 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia. Results: NIH-SS and dysphagia severity show a significant positive correlation in the whole study population (R² = 0.745) as well as in both analysed subgroups (R² = 0.494 for supra- and R² = 0.646 for infratentorial strokes, p < 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is > 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off > 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%). Conclusions: NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.

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Section: Limitationssupporting

confidence: 84%

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

et al. 2018

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“…Our findings are in the lower range of previous reports indicating that dysphagia is present in one-third to onehalf of the patients with acute stroke. [2][3][4][5][6][7] Although swallowing function improves during the first days after the stroke in many patients, 38 appropriate management is essential not only to prevent aspiration pneumonia but also to ensure that nutritional needs are met early.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in different patient populations indicate that up to half of the patients admitted to hospital with acute stroke may be undernourished and that probably as many initially present with dysphagia. [1][2][3][4][5][6][7] Undernutrition develops as a consequence of insufficient protein and energy intake over time, leading to altered body composition and impaired biological function. In patients with acute stroke, undernutrition is an independent risk factor for poorer functional outcomes that is potentially modifiable.…”

Section: Introductionmentioning

confidence: 99%

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Kampman

Eltoft

Karaliute

et al. 2015

The Neurohospitalist

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Background and Purpose: In patients with acute stroke, undernutrition and aspiration pneumonia are associated with increased mortality and length of hospital stay. Formal screening for nutritional risk and dysphagia helps to ensure optimal nutritional management in all patients with stroke and to reduce the risk of aspiration in patients with dysphagia. We developed a national guideline for nutritional and dysphagia screening in acute stroke, which was introduced in our stroke unit on June 1, 2012. The primary objective was to audit adherence to the guideline and to achieve full implementation. Second, we assessed the prevalence of nutritional risk and dysphagia. Methods: We performed a chart review to assess performance of screening for nutritional risk and dysphagia in all patients with stroke hospitalized for ≥ 48 hours between June 1, 2012, and May 31, 2013. Next we applied a ''clinical microsystems approach'' with rapid improvement cycles and audits over a 6-month period to achieve full implementation. Results: The chart review showed that nutritional risk screening was performed in 65% and swallow testing in 91% of eligible patients (n ¼ 185). Proactive implementation resulted in >95% patients screened (n ¼ 79). The overall prevalence of nutritional risk was 29%, and 23% of the patients failed the initial swallow test. Conclusions: Proactive implementation is required to obtain high screening rates for nutritional risk and swallowing difficulties using validated screening tools. The proportion of patients at nutritional risk and the prevalence of dysphagia at initial swallow test were in the lower range of previous reports.

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“…But there are only few studies published that searched for predictors of dysphagia in stroke patients in general [10,11,12,13,14]. Infratentorial stroke location and right-sided infarctions are usually considered to be associated with swallowing dysfunction, although scientific evidence supporting this assumption is weak [15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Early Screening Parameters for Dysphagia in Acute Ischemic Stroke

2017

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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.

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The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke

Cited by 196 publications

References 51 publications

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

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

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Early Screening Parameters for Dysphagia in Acute Ischemic Stroke

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