Tolerance of early diet textures as indicators of recovery from dysphagia after stroke.
We undertook this 12-month retrospective cohort study, of 186 teaching hospital inpatients, to determine how tolerance of differing diet textures after a stroke predicts recovery from dysphagia. Outcome measures were insertion of a percutaneous endoscopic gastrostomy (PEG) tube and/or ability to tolerate a normal diet 28 days after the stroke. Likelihood ratios for needing a PEG were highest for intolerance of pureed food. People who tolerated grade 1 fluids (300-600 cP) or thinner, or who tolerated a modified soft diet or better, 7 days after the stroke did not need a PEG. Half (13/26) the people who could not tolerate grade 3 thickened fluids (10,000-12,000 cP) and 52% (13/25) of people who could not tolerate a puree diet 14 days after the stroke needed a PEG. No one who was intolerant of grade 2 thickened fluids (4000-7000 cP) 7 or 14 days after the stroke could tolerate a normal diet and fluids by day 28. If people were tolerating grade 3 thickened fluids at day 7, the proportion tolerating a normal diet at day 28 was 36%. We present similar data for tolerance of differing fluids and diets at each of the measured time points. We suggest a PEG should be considered in people unable to tolerate grade 3 thickened fluids or a puree diet 14 days after their stroke. However, even in these groups, half will recover sufficiently to manage oral feeding.
Christchurch School of Medicine and Health Sciences, New Zealand. tim.wilkinson@chmeds.ac.nz
Tim J
TJ
Wilkinson
Kerry
K
Thomas
Sarita
S
MacGregor
Gina
G
Tillard
Christine
C
Wyles
Richard
R
Sainsbury
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications*; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004435:Eating; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies