Highlights
- •We enrolled 6000 patients with ischemic stroke from a nationwide prospective cohort.
- •The incidence of dysphagia was 32.3% (n=1940) at 7 days after ischemic stroke.
- •At the time of discharge, 80.5% (n=1561) of the patients still had dysphagia.
- •Age, body mass index, and premorbid disabilities contribute to poststroke dysphagia.
Abstract
Objective
To identify the incidence of dysphagia after ischemic stroke and determine factors
affecting the presence of dysphagia.
Design
Retrospective case-control study. This was an interim analysis of a prospective multicenter
Korean stroke cohort.
Setting
Acute care university hospitals.
Participants
Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into
2 groups according to the presence or absence of dysphagia confirmed at 7 days after
onset using the American Speech-Language-Hearing Association National Outcomes Measurement
System (ASHA-NOMS) scale, which was determined after conducting screening or standardized
tests.
Interventions
Not applicable.
Main Outcome Measures
Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS),
brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), poststroke
mRS, and ASHA-NOMS swallowing level at poststroke day 7 were evaluated.
Results
Among patients with ischemic stroke, 32.3% (n=1940) had dysphagia at 7 days after
stroke onset. At discharge, 80.5% (n=1561) still had dysphagia. The prediction model
for the presence of dysphagia identified age at onset, underweight (BMI <18.5 kg/m2), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds
ratio (OR) for the presence of dysphagia significantly increased with underweight
(OR, 1.6684; 95% confidence interval [CI], 1.27-2.20), increased age at onset (OR,
1.0318; 95% CI, 1.03-1.04), premorbid mRS (OR, 1.1832; 95% CI, 1.13-1.24), brainstem
lesions (OR, 1.6494; 95% CI, 1.39-1.96), and NIHSS (OR, 1.2073; 95% CI, 1.19-1.23).
Conclusions
The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for
the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem
lesions, and NIHSS as predictive factors.
Keywords
List of abbreviations:
ASHA-NOMS (American Speech-Language-Hearing Association National Outcomes Measurement System), BMI (body mass index), CI (confidence interval), FEES (fiberoptic endoscopic evaluation of swallowing test), FMA (Fugl-Meyer assessment), KOSCO (Korean Stroke Cohort for Functioning and Rehabilitation), MMSE (Mini-Mental State Examination), mRS (modified Rankin Scale), NIHSS (National Institutes of Health Stroke Scale), OR (odds ratio), VFSS (videofluoroscopic swallowing study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 02, 2021
Accepted:
July 1,
2021
Received in revised form:
June 24,
2021
Received:
February 15,
2021
Footnotes
Supported by a research program funded by the Korea Centers for Disease Control and Prevention (grant no. 2019E320202) and by a grant of the MD-PhD/Medical Scientist Training Program through the Korea Health Industry Development Institute and funded by the Ministry of Health and Welfare, Republic of Korea.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
