Incidence of dysphagia in acute stroke patients-a prospective multicentre cohort study

The incidence of dysphagia after stroke remains uncertain in the context of contemporary stroke care. Reported estimates vary widely due to heterogenous assessment methods and limited use of standardized and validated evaluations. Dysphagia is also frequently underestimated despite its strong associations with increased mortality, morbidity, and pneumonia-related hospitalisation. Reliable estimates on incidence based on standardized swallowing assessments are therefore needed to improve identification of dysphagia and to improve clinical management. This study was conducted within the framework of the large prospective multicenter study Dysphagia Evaluation after Stroke (DESIRE) to address these knowledge gaps. Thus, the objective was to determine the incidence of dysphagia in the acute phase following stroke in patients receiving current stroke care using standardized assessment methods, and to identify factors independently associated with post-stroke dysphagia.

Consecutive acute stroke patients admitted to four Swedish stroke units were assessed within 96 h after stroke onset using the Gugging Swallowing Screen (GUSS) administered by a speech-language pathologist. Clinical data on stroke characteristics, dysphagia risk factors, pneumonia incidence, and discharge destination were prospectively collected. Multivariable regression models were used to identify factors associated with dysphagia.

Of 1,093 patients (468 women, 42.8%; median age 75 years), the incidence of dysphagia was 38.8%. Independent predictors of dysphagia included dysarthria (adjusted odds ratio [aOR]: 1.85, CI = 1.32-2.59, p = <0.001), greater stroke severity (aOR: 1.16, CI = 1.12-1.19, p = <0.001), female sex (aOR: 1.39, CI = 1.00-1.92, p = <0.047), infratentorial lesions (aOR: 2.01, CI = 1.10-3.69, p = 0.024) and older age (p = <0.001). Dysphagia was significantly associated with longer hospital stay (ratio of mean: 1.64, CI = 1.36-1.98, p = <0.001), and with increased odds of discharge to nursing homes (aOR: 4.84, CI = 2.46-9.56, p = <0.001), short-term care facilities (aOR: 4.69, CI = 1.87-11.76, p = <0.001) or in-hospital death (aOR: 16.67, CI = 2.10-132.05, p = 0.008).

Dysphagia affected more than one third of acute stroke patients, and was associated with greater stroke severity, extended hospitalisation, and adverse discharge outcomes. These findings underscore the need for early identification and targeted management of dysphagia to reduce complications and improve patients' outcomes.