Complications and outcome after acute stroke. Does dysphagia matter?
OBJECTIVE
The published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside assessment and videofluoroscopic examination.


METHODS
We prospectively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We performed videofluoroscopy blinded to this assessment within 3 days of stroke onset and within a median time of 24 hours of the bedside evaluations. The presence of aspiration was recorded. Mortality, functional outcome, lengthy of stay, place of discharge, occurrence of chest infection, nutritional status, and hydration were the main outcome measures.


RESULTS
Patients with an abnormal swallow (dysphagia) on bedside assessment had a higher risk of chest infection (P=.05) and a poor nutritional state (P=.001). The presence of dysphagia was associated with an increased risk of death (P=.001), disability (P=.02), length of hospital stay (P<.001), and institutional care (P<.05). When other factors were taken into account, dysphagia remained as an independent predictor of outcome only with regard to mortality. The use of videofluoroscopy in detecting aspiration did not add to the value of bedside assessment.


CONCLUSIONS
Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.
Smithard
D G
DG
University Department of Geriatric Medicine, South Manchester University Hospitals Trust, UK.
O'Neill
P A
PA
Parks
C
C
Morris
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000628:therapy; D002933:Cineradiography; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005544:Forecasting; D005547:Foreign Bodies / Q000209:etiology; D006801:Humans; D007326:Institutionalization; D007902:Length of Stay; D008168:Lung; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010351:Patient Discharge; D010362:Patients' Rooms; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000209:etiology; D016037:Single-Blind Method; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance