title: Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit.
abstract: OBJECTIVE
  We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients.
  
  
  METHODS
  In all, 151 consecutive inpatients with recent ischemic or hemorrhagic stroke were enrolled.
  
  
  RESULTS
  Dysphagia was clinically diagnosed in 62 of 151 patients (41%). A total of 49 patients (79% of clinically dysphagic patients) underwent VFS. Six patients clinically suggested to be dysphagic had a normal VFS finding. The correlation between clinical and VFS diagnosis of dysphagia was significant (r = 0.6505). Penetrations and aspirations were observed, respectively, in 42.8% and 26.5% of patients with dysphagia, with 12.2% classified as silent. Lower respiratory tract infections were observed in 5.9%, more frequently in patients with dysphagia (30%). Dysphagia was not influenced by type of stroke. Cortical stroke of nondominant side was associated with dysphagia (P = .0322) and subcortical nondominant stroke showed a reduced frequency of dysphagia (P = .0008). Previous cerebrovascular disease resulted associated to dysphagia (P = .0399). Patients with dysphagia had significantly lower functional independence measurement (FIM) and level of cognitive functioning on admission and lower FIM on discharge, longer hospital stay, and more frequent malnutrition, and they were more frequently aphasic and dysarthric. Percutaneous endoscopic gastrostomy was used in 18 of 151 patients (11.9%) (41.8% of patients with VFS-proved dysphagia).
  
  
  CONCLUSIONS
  Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.
authors.affiliation: Neurorehabilitation, Local Health Unit 8, S. Donato Hospital, Arezzo, Italy. paolo.falsetti@virgilio.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Falsetti
authors.forename: Caterina
authors.initials: C
authors.lastname: Acciai
authors.forename: Rosanna
authors.initials: R
authors.lastname: Palilla
authors.forename: Marco
authors.initials: M
authors.lastname: Bosi
authors.forename: Francesco
authors.initials: F
authors.lastname: Carpinteri
authors.forename: Alberto
authors.initials: A
authors.lastname: Zingarelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Pedace
authors.forename: Lucia
authors.initials: L
authors.lastname: Lenzi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000453:epidemiology; D054022:Cerebrum / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000534:rehabilitation; D004185:Disability Evaluation; D004292:Dominance, Cerebral / Q000502:physiology; D004401:Dysarthria / Q000453:epidemiology; D005260:Female; D005471:Fluoroscopy; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D011237:Predictive Value of Tests; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology