[Swallowing changes in cerebrovascular accidents: incidence, natural history, and repercussions on the nutritional status, morbidity, and mortality].
OBJECTIVE
To determine the frequency of dysphagia in CVA, its natural history and value as a risk factor of respiratory infection, malnutrition and death.


METHODS
A prospective study was made of 187 consecutive patients with cerebrovascular accidents (CVA). A standardized test for dysphagia was done during the first two days of the illness and repeated three days a week. The levels of urea, total proteins and albumin were determined on admission and on discharge. The patients were questioned by phone after 6 months.


RESULTS
There was dysphagia of liquids in 36.4% of the patients. The incidence of dysphagia for semisolids was of the same frequency but more severe. Coma was the cause of inability to swallow in 25.7% of the patients. During their stay in hospital one third of the patients with dysphagia died, one third became normal and one third still had dysphagia when they were discharged. After one week, one, three and six months respectively, the cure rate for dysphagia was 29.4%, 4.1%, 55.9% and 55.9%, and survival 83.8%, 67.6%, 61.8% and 60.3%. Thus after 6 months only 3 patients (4.4%) were alive and dysphagic. Half of the 'cures' occurred in the first week, and none occurred after more than 77 days. As compared to the non-dysphagic patients, the dysphagic patients had 10 times more risk of respiratory infection, 18 times higher risk of death, greater loss of albumin and less loss of urea.


CONCLUSIONS
There is a high prevalence of dysphagia in CVA and although functional prognosis is not unfavorable, respiratory infections, malnutrition and death are frequent.
Sala
R
R
Unidad de Enfermería de Medicina Interna, Hospital Virgen de los Lirios, Alcoy, Alicante, España.
Muntó
M J
MJ
de la Calle
J
J
Preciado
I
I
Miralles
T
T
Cortés
A
A
Molla
R
R
Alcaide
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000032:analysis; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000097:blood / Q000150:complications*; D015331:Cohort Studies; D015897:Comorbidity; D003244:Consciousness Disorders / Q000453:epidemiology / Q000209:etiology; D003680:Deglutition Disorders / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D003681:Dehydration / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004032:Diet; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009748:Nutrition Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D009752:Nutritional Status; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013030:Spain / Q000453:epidemiology; D014508:Urea / Q000097:blood
D001798:Blood Proteins; D012709:Serum Albumin; D014508:Urea
Alteraciones de la deglución en el accidente cerebrovascular: incidencia, historia natural y repercusiones sobre el estado nutricional, la morbilidad y la mortalidad.