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Status Of Dysphagia After Ischemic Stroke: A Korean Nationwide Study

Published:August 02, 2021DOI:https://doi.org/10.1016/j.apmr.2021.07.788

      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)
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