Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study.
OBJECTIVE
To examine the effect of dysphasia and dysphagia on stroke outcome.


METHODS
Retrospective database study.


METHODS
Norfolk, United Kingdom.


METHODS
Two thousand nine hundred eighty-three men and women with stroke admitted to the hospital between 1997 and 2001.


METHODS
Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria.


RESULTS
Two thousand nine hundred eighty-three patients (1,330 (44.6%) male), median age 78 (range 17-105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8-2.7) and 1.4 (95% CI=1.2-1.6) for dysphasia; 12.5 (95% CI=8.9-17.3) and 3.9 (95% CI=3.3-4.6) for dysphagia, 5.5 (95% CI=3.7-8.2), 1.9 (95% CI=1.6-2.3) for either, and 13.8 (95% CI=9.4-20.4) and 3.7 (95% CI=3.1-4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively.


CONCLUSIONS
Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity or results from problems related directly to dysphagia is unclear.
Guyomard
Veronique
V
Stroke Unit, Department of Medicine for the Elderly, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk NR4 7TJ, United Kingdom. v.guyomard@fsmail.net
Fulcher
Robert A
RA
Redmayne
Oliver
O
Metcalf
Anthony K
AK
Potter
John F
JF
Myint
Phyo K
PK
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000401:mortality*; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000401:mortality; D002544:Cerebral Infarction / Q000401:mortality; D003680:Deglutition Disorders / Q000401:mortality*; D004185:Disability Evaluation; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality*; D055815:Young Adult