Long-term outcome after stroke: does dysphagia matter?
BACKGROUND
swallowing problems (dysphagia) are common following acute stroke and are independent predictors of short-term outcome. It is uncertain as to whether these swallowing problems are associated with outcome in the longer-term.


OBJECTIVE
insert to determine whether dysphagia present in the first week of acute stroke associated with long-term outcome.


METHODS
a population-based long-term follow-up of people with first in a life-time stroke. Dysphagia was assessed within 1 week of stroke and patients were followed up at 3 months and yearly for 5 years by face-to-face interview. Outcome was defined by survival and place of residence, using multinomial logistic regression. Barthel Scores were divided into the two groups 15-20 and 0-14, and modelled using multiple logistic regression.


RESULTS
there were 567 patients with dysphagia (mean age 74.3 years) and 621 with a safe swallow (mean age 69.6 years). Following multinomial logistic regression, residence in a nursing home was more likely to occur in those who failed the swallow test during the first week of their stroke; however, this only reached statistical significance at 3 months (relative risk ratio (RRR)=1.73; 95% confidence interval (CI) 1.02 to 2.95), and years 4 (RRR 3.35, 1.37-8.19) and 5 (RRR 3.06, 1.06-8.83). There was also a significant association with increased mortality only during the first three months (RRR 2.03, 1.12 to 3.67).


CONCLUSIONS
this study confirms that the presence of dysphagia during the acute phase of stroke is associated with poor outcome during the subsequent year, particularly at 3 months, and is associated with increased institutionalisation rate in the long term.
Smithard
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DG
Richard Stevens Ward, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK. david.smithard@ekht.nhs.uk
Smeeton
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NC
Wolfe
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CD
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000401:mortality; D000071939:Stroke Rehabilitation