Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Marcel Arnold, Kai Liesirova, Anne Broeg-Morvay, Julia Meisterernst, Markus Schlager, Marie-Luise Mono, Marwan El-Koussy, Georg Kägi, Simon Jung, Hakan Sarikaya, Marcel Arnold, Kai Liesirova, Anne Broeg-Morvay, Julia Meisterernst, Markus Schlager, Marie-Luise Mono, Marwan El-Koussy, Georg Kägi, Simon Jung, Hakan Sarikaya

Abstract

Background: Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke.

Methods: We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia.

Results: Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, p<0.001), stayed longer at monitored stroke unit beds (4.4±2.8 vs. 2.7±2.4 days; p<0.001) and were less often discharged to home (19.5% vs. 63.7%, p = 0.001) as compared to those without dysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; p<0.001), less often lived at home (38.8% vs. 76.5%; p<0.001), and more often had died (13.6% vs. 1.6%; p<0.001). Multivariate analyses identified dysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality.

Conclusion: Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization.

Conflict of interest statement

Competing Interests: This study was supported by Nestec S.A. The terms of arrangement are in accordance with the policy on objectivity in research of the University Hospital of Berne. The funders had no role in study design, data collection and analysis, decision to publish, preparation or writing of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Comparison of outcome variables in…
Fig 1. Comparison of outcome variables in dysphagic and non-dysphagic patients.

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