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
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Article info
Publication history
Accepted:
January 13,
2009
Received:
January 1,
2009
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009
Copyright
© 2009 National Stroke Association. Published by Elsevier Inc. All rights reserved.
