Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study. Issue 8 (23rd March 2018)

• Record Type: Journal Article
• Authors: Rofes, L.; Muriana, D.; Palomeras, E.; Vilardell, N.; Palomera, E.; Alvarez‐Berdugo, D.; Casado, V.; Clavé, P.
• Is Part Of: Neurogastroenterology & motility. Volume 30:Issue 8(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-03-23
• Subjects: cohort study -- dysphagia -- prevalence studies -- risk factors -- stroke; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13338
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Oropharyngeal dysphagia (OD) is a prevalent poststroke condition with severe complications and increased mortality. Poststroke OD prevalence varies among studies and there is little evidence of its related risk factors and associated complications. Objective: to evaluate the prevalence of OD after stroke and the risk factors and associated complications. Methods: We performed a prospective longitudinal study of stroke patients consecutively admitted to a general hospital. OD was diagnosed with the volume‐viscosity swallow test (V‐VST). Demographic, functional status and topographical and clinical variables of stroke were collected to assess risk factors for OD. We evaluated functional status, mortality, respiratory infections, and readmissions 3 and 12 months after stroke. A multivariate regression analysis determined associated risk factors for OD and for each outcome variable. Key Results: We included 395 stroke patients with a 45.06% prevalence of OD on admission. OD was independently associated with age (OR = 1.05; CI = 1.02‐1.08), previous stroke (OR = 2.40; CI = 1.00‐5.79), severity using the National Institute of Health Stroke Scale (OR = 3.52; CI = 1.57‐7.87) and volume of the lesion (OR = 1.02; CI = 1.01‐1.03). OD after stroke was an independent risk factor for prolonged hospital stay ( P = .049; β = 0.938) and institutionalization after discharge (OR = 0.47; CI = 0.24‐0.92); OD was an independent risk factor for poorer functional capacity (OR = 3.00; CI = 1.58‐5.68) and increased mortality (HR = 6.90; CI = 1.57‐30.34) 3 months after stroke. Conclusions & Inferences: Poststroke OD is prevalent and associated with poor short and long term prognosis. Stroke severity and patient status before stroke were more relevant to OD than lesion location. Systematic screening programs and early OD management could significantly improve poststroke patient outcome. Abstract : Despite the high impact that OD has on stroke patient prognosis, poststroke dysphagia remains a neglected area of research. Our study had three main aims: to determine the prevalence of OD in acute stroke patients admitted to a general hospital; to establish socio‐demographic and clinical risk factors for poststroke OD, and to determine the impact of OD on the clinical outcome and 1‐year prognosis of the patient. We found a high prevalence (45.06%) of poststroke OD on admission. Older age, previous stroke diagnosis, severity of stroke according to NIHSS, and high stroke lesion volume were independent risk factors for OD development after a stroke. Moreover, we found that presenting OD after stroke was associated with high mortality rates during hospital stay and was an independent risk factor for prolonged length of hospital stay and institutionalization after hospital discharge; OD was also an independent risk factor for poorer functional capacity and increased risk of mortality 3 months after the stroke episode.