Clinical significance of oral intake in patients with acute stroke.
We investigated the feeding method and predictors for oral intake difficulty for a month after acute stroke. In 107 consecutive patients, swallowing function was assessed using a bedside screening protocol within 48 h of admission. The method of feeding was followed for 4 weeks, and predictors for "non-oral intake" on admission and 4 weeks later were analyzed. Sixty-two patients (58%) were fed any type of food orally within 48 h of admission, and 91 patients (84%) were fed orally 4 weeks later. Independent predictors for non-oral intake within 48 h of admission were consciousness disturbance (not completely alert; OR = 12.3), absence of gag reflex (OR = 5.34), and NIHSS score (OR = 1.20 per one point). Independent predictors for non-oral intake after 4 weeks were absence of gag reflex (OR = 7.95) and NIHSS score (OR = 1.13 per one point) on admission. Only four (9%) patients in the non-oral intake group within 48 h of admission and no patients in the non-oral intake group 4 weeks after admission were discharged to home. In acute stroke patients, absence of the gag reflex and severe neurologic deficits on admission predict prolonged dysphagia lasting longer than a month. Patients who could not eat orally had poor outcome.
Nakajima
Makoto
M
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Japan. nakazima@fc.kuh.kumamoto-u.ac.jp
Takada
Tatsuro
T
Terasaki
Yasukazu
Y
Nagano
Keiko
K
Naritomi
Hiroaki
H
Minematsu
Kazuo
K
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology* / Q000517:prevention & control / Q000534:rehabilitation; D005248:Feeding Methods; D005260:Female; D005683:Gagging; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome