Swallowing Dysfunction after Acute Stroke: The Incidence, Predictors and Outcome

Area of Science:

• Neurology
• Gastroenterology
• Speech and Language Pathology

Background:

• Swallowing dysfunction (dysphagia) is a frequent complication following acute stroke.
• Dysphagia increases risks of aspiration pneumonia and malnutrition, impacting patient recovery.
• Early identification and management of post-stroke dysphagia are crucial for improving outcomes.

Purpose of the Study:

• To determine the incidence of dysphagia in conscious patients after a single acute stroke.
• To identify factors predisposing patients to post-stroke dysphagia.
• To evaluate the natural course of dysphagia over an 8-week period.

Main Methods:

• Prospective observational study including 150 conscious acute stroke patients (GCS ≥12) within 48 hours of onset.
• Dysphagia screening using the Gugging Swallowing Screen (GUSS) and detailed assessment with the Mann Assessment of Swallowing Ability (MASA) scale.
• Follow-up reassessments at 7 days and 8 weeks to track dysphagia presence and severity.

Main Results:

• Initial dysphagia incidence was 42%, decreasing to 24% at 7 days and 9% at 8 weeks.
• Moderate and severe dysphagia reduced from 18% to 3% and 20% to 6%, respectively, over 8 weeks.
• Higher stroke severity (NIHSS 5-14), total anterior circulation infarct (TACI), and posterior circulation strokes were associated with increased dysphagia incidence and longer hospital stays.

Conclusions:

• All stroke patients, including those with unilateral hemispheric strokes and fully conscious individuals, require dysphagia screening.
• While swallowing function generally improves over time, feeding assistance may be necessary in the acute phase.
• Dysphagia is more prevalent in strokes with higher NIHSS scores, greater brain parenchyma involvement, and posterior circulation lesions.