Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit

Falsetti, Paolo; Acciai, Caterina; Palilla, Rosanna; Bosi, Marco; Carpinteri, Francesco; Zingarelli, Alberto; Pedace, Claudio; Lenzi, Lucia

doi:10.1016/j.jstrokecerebrovasdis.2009.01.009

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 5 , Pages 329-335, September 2009

Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit

Paolo Falsetti, MD, PhD
- Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
- Address correspondence to Paolo Falsetti, MD, PhD, Neurorehabilitation Unit, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy.
Caterina Acciai, MD, PhD
- Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Rosanna Palilla, MD
- Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Marco Bosi, MD
- Radiology, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Francesco Carpinteri, MD
- Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Alberto Zingarelli, MD
- Radiology, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Claudio Pedace, MD
- Internal Medicine and Geriatrics Units, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy
Lucia Lenzi, MD
- Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy

Received 1 January 2009; accepted 13 January 2009.

Objective

We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients.

Methods

In all, 151 consecutive inpatients with recent ischemic or hemorrhagic stroke were enrolled.

Results

Dysphagia was clinically diagnosed in 62 of 151 patients (41%). A total of 49 patients (79% of clinically dysphagic patients) underwent VFS. Six patients clinically suggested to be dysphagic had a normal VFS finding. The correlation between clinical and VFS diagnosis of dysphagia was significant (r = 0.6505). Penetrations and aspirations were observed, respectively, in 42.8% and 26.5% of patients with dysphagia, with 12.2% classified as silent. Lower respiratory tract infections were observed in 5.9%, more frequently in patients with dysphagia (30%). Dysphagia was not influenced by type of stroke. Cortical stroke of nondominant side was associated with dysphagia (P = .0322) and subcortical nondominant stroke showed a reduced frequency of dysphagia (P = .0008). Previous cerebrovascular disease resulted associated to dysphagia (P = .0399). Patients with dysphagia had significantly lower functional independence measurement (FIM) and level of cognitive functioning on admission and lower FIM on discharge, longer hospital stay, and more frequent malnutrition, and they were more frequently aphasic and dysarthric. Percutaneous endoscopic gastrostomy was used in 18 of 151 patients (11.9%) (41.8% of patients with VFS-proved dysphagia).

Conclusions

Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.

Key Words: Dysphagia, stroke, videofluoroscopy, percutaneous endoscopic gastrostomy