Sandeep Kumar1, Christopher Doughty2, Gheorghe Doros3, Magdy Selim4, Sourabh Lahoti4, Sankalp Gokhale4, Gottfried Schlaug4. 1. Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: skumar@bidmc.harvard.edu. 2. Harvard Medical School, Boston, Massachusetts. 3. Department of Biostatistics, Boston University, Boston, Massachusetts. 4. Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
BACKGROUND: Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify important prognostic variables affecting swallowing recovery after acute ischemic stroke. METHODS: We retrospectively reviewed our patient database to identify acute ischemic stroke patients who developed dysphagia after stroke but were free of other confounding conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness (LOC), facial weakness, dysarthria, neglect, bihemispheric infarcts, right hemispheric infarcts, brainstem infarcts, intubation, aspiration, acute stroke therapies, occurrence of symptomatic hemorrhagic transformation, seizures, pneumonia, and length of hospitalization (LOH) on persistence of dysphagia at hospital discharge in a logistic regression analysis. RESULTS: The mean age and NIHSS scores (mean ± standard deviation) were 75.9 ± 13.6 years and 13.5 ± 6.9, respectively; 58.5% were women. In a multivariate analysis, aspiration detected on a clinical swallowing evaluation (odds ratio [OR] 21.83; 95% confidence interval [CI] 8.16-58.42; P < .0001), aspiration on videofluoroscopic swallowing study (OR 10.50; 95% CI 3.35-32.96; P < .0001), bihemispheric infarcts (OR 3.72; 95% CI 1.33-10.43; P = .0123), dysarthria (OR 3.4; 95% CI 1.57-7.35; P = .0019), intubation (OR 2.86; 95% CI 1.10-7.39; P = .0301), NIHSS score ≥12 (OR 2.51; 95% CI 1.19-5.23; P = .0157) were significant predictors of persistent dysphagia. The area under the curve and Somer's Dxy statistics of the model were 0.8918 and 0.78, respectively, indicating good calibration and discriminative power. CONCLUSIONS: Prognostic factors affecting swallowing recovery identified in this study can help advance dysphagia research methodologies and the clinical care of stroke patients.
BACKGROUND:Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify important prognostic variables affecting swallowing recovery after acute ischemic stroke. METHODS: We retrospectively reviewed our patient database to identify acute ischemic strokepatients who developed dysphagia after stroke but were free of other confounding conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness (LOC), facial weakness, dysarthria, neglect, bihemispheric infarcts, right hemispheric infarcts, brainstem infarcts, intubation, aspiration, acute stroke therapies, occurrence of symptomatic hemorrhagic transformation, seizures, pneumonia, and length of hospitalization (LOH) on persistence of dysphagia at hospital discharge in a logistic regression analysis. RESULTS: The mean age and NIHSS scores (mean ± standard deviation) were 75.9 ± 13.6 years and 13.5 ± 6.9, respectively; 58.5% were women. In a multivariate analysis, aspiration detected on a clinical swallowing evaluation (odds ratio [OR] 21.83; 95% confidence interval [CI] 8.16-58.42; P < .0001), aspiration on videofluoroscopic swallowing study (OR 10.50; 95% CI 3.35-32.96; P < .0001), bihemispheric infarcts (OR 3.72; 95% CI 1.33-10.43; P = .0123), dysarthria (OR 3.4; 95% CI 1.57-7.35; P = .0019), intubation (OR 2.86; 95% CI 1.10-7.39; P = .0301), NIHSS score ≥12 (OR 2.51; 95% CI 1.19-5.23; P = .0157) were significant predictors of persistent dysphagia. The area under the curve and Somer's Dxy statistics of the model were 0.8918 and 0.78, respectively, indicating good calibration and discriminative power. CONCLUSIONS: Prognostic factors affecting swallowing recovery identified in this study can help advance dysphagia research methodologies and the clinical care of strokepatients.
Authors: Marian Galovic; Anne Julia Stauber; Natascha Leisi; Werner Krammer; Florian Brugger; Jochen Vehoff; Philipp Balcerak; Anna Müller; Marlise Müller; Jochen Rosenfeld; Alexandros Polymeris; Sebastian Thilemann; Gian Marco De Marchis; Thorsten Niemann; Maren Leifke; Philippe Lyrer; Petra Saladin; Timo Kahles; Krassen Nedeltchev; Hakan Sarikaya; Simon Jung; Urs Fischer; Concetta Manno; Carlo W Cereda; Josemir W Sander; Barbara Tettenborn; Bruno J Weder; Sandro J Stoeckli; Marcel Arnold; Georg Kägi Journal: JAMA Neurol Date: 2019-05-01 Impact factor: 18.302
Authors: Antonio Muscari; Roberta Falcone; Enrico Pirazzoli; Luca Faccioli; Silvia Muscari; Marco Pastore Trossello; Giovanni M Puddu; Loredana Rignanese; Luca Spinardi; Marco Zoli Journal: Dysphagia Date: 2022-06-09 Impact factor: 3.438