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Complications and outcome after acute stroke. Does dysphagia matter?
D G Smithard1, P A O'Neill, C Parks
1University Department of Geriatric Medicine, South Manchester University Hospitals Trust, UK.
Stroke
|July 1, 1996
Summary
Bedside swallowing assessment effectively identifies stroke patients at risk for complications like chest infections and poor nutrition. This method is valuable for predicting outcomes, including mortality, and questioning the routine use of videofluoroscopy for aspiration detection.
Area of Science:
- Neurology
- Clinical Medicine
- Swallowing Disorders
Background:
- Inconclusive data exists on dysphagia's impact on stroke outcomes.
- Bedside assessment and videofluoroscopy were used to evaluate swallowing post-stroke.
Purpose of the Study:
- To examine the relationship between dysphagia and outcomes/complications after acute stroke.
- To compare the utility of bedside assessment versus videofluoroscopy in identifying aspiration.
Main Methods:
- 121 acute stroke patients were prospectively studied.
- Standardized physician bedside swallowing assessment was performed.
- Videofluoroscopy was conducted within 3 days of stroke onset, blinded to bedside assessment.
Main Results:
- Dysphagia on bedside assessment correlated with higher risk of chest infection (P=.05) and poor nutrition (P=.001).
- Dysphagia predicted increased mortality (P=.001), disability (P=.02), longer hospital stay (P<.001), and institutional discharge (P<.05).
- Videofluoroscopy did not enhance the predictive value of bedside assessment for aspiration detection.
Conclusions:
- Bedside swallowing assessment is a useful tool for identifying stroke patients at risk of complications.
- Routine videofluoroscopy screening for aspiration in stroke patients is questioned based on these findings.