Recovery of swallowing after dysphagic stroke: An analysis of prognostic factors

Sandeep Kumar, Christopher Doughty, Gheorghe Doros, Magdy Selim, Sourabh Lahoti, Sankalp Gokhale, Gottfried Schlaug

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Background: Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify important prognostic variables affecting swallowing recovery after acute ischemic stroke. Methods: We retrospectively reviewed our patient database to identify acute ischemic stroke patients who developed dysphagia after stroke but were free of other confounding conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness (LOC), facial weakness, dysarthria, neglect, bihemispheric infarcts, right hemispheric infarcts, brainstem infarcts, intubation, aspiration, acute stroke therapies, occurrence of symptomatic hemorrhagic transformation, seizures, pneumonia, and length of hospitalization (LOH) on persistence of dysphagia at hospital discharge in a logistic regression analysis. Results: The mean age and NIHSS scores (mean ± standard deviation) were 75.9 ± 13.6 years and 13.5 ± 6.9, respectively; 58.5% were women. In a multivariate analysis, aspiration detected on a clinical swallowing evaluation (odds ratio [OR] 21.83; 95% confidence interval [CI] 8.16-58.42; P <.0001), aspiration on videofluoroscopic swallowing study (OR 10.50; 95% CI 3.35-32.96; P <.0001), bihemispheric infarcts (OR 3.72; 95% CI 1.33-10.43; P =.0123), dysarthria (OR 3.4; 95% CI 1.57-7.35; P =.0019), intubation (OR 2.86; 95% CI 1.10-7.39; P =.0301), NIHSS score ≥12 (OR 2.51; 95% CI 1.19-5.23; P =.0157) were significant predictors of persistent dysphagia. The area under the curve and Somer's Dxy statistics of the model were 0.8918 and 0.78, respectively, indicating good calibration and discriminative power. Conclusions: Prognostic factors affecting swallowing recovery identified in this study can help advance dysphagia research methodologies and the clinical care of stroke patients.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Dysphagia
  • multivariate logistic regression analysis
  • predictors
  • prognosis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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