title: Can the aspiration detected by videofluoroscopic swallowing studies predict long-term survival in stroke patients with dysphagia?
abstract: OBJECTIVE
  This study aimed to evaluate whether the aspiration detected by videofluoroscopic swallowing study (VSS) could predict the long-term survival in stroke patients with dysphagia in the post-acute phase of stroke.
  
  
  METHODS
  A cohort of 182 consecutive patients with stroke-related dysphagia referred for VSS from July 1994 to April 1999 was retrospectively constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. The records thus obtained were then linked to the National Death Register to track the occurrence of patient deaths until December 31, 2000.
  
  
  RESULTS
  Of the 182 patients, 91 (50%) showed aspiration during VSS performed for a median duration of 8.4 weeks after stroke, and 76 (42%) had silent aspiration. In the post-acute phase of stroke (14.7 +/- 8.7 weeks after stroke, mean + standard deviation), 56 (31%) were tube-fed, and 88 (48%) were wheelchair-confined. A total of 65 patients died in a median follow-up duration of 30.8 months after VSS. Patients were classified into three groups based on the findings of VSS-detected aspiration or penetration, but no difference was noted in their survival curves. In the Cox stepwise regression analysis, only advanced age, recurrent stroke (hazard ratio 1.74, 95% CI 1.06-2.85), the need of tube-feeding (hazard ratio 2.07, 95% CI 1.19-3.59), and being wheelchair-confined (hazard ratio 2.83, 95% CI 1.54-5.19) during follow-up were independent predictors of long-term survival.
  
  
  CONCLUSIONS
  VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia.
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Ssu-Yuan
authors.initials: SY
authors.lastname: Chen
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.forename: Yi-Nien
authors.initials: YN
authors.lastname: Lin
authors.forename: Yeun-Chung
authors.initials: YC
authors.lastname: Chang
authors.forename: Tyng-Guey
authors.initials: TG
authors.lastname: Wang
authors.forename: I-Nan
authors.initials: IN
authors.lastname: Lien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016019:Survival Analysis