title: Recovery of swallowing after dysphagic stroke: an analysis of prognostic factors.
abstract: BACKGROUND
  Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify important prognostic variables affecting swallowing recovery after acute ischemic stroke.
  
  
  METHODS
  We retrospectively reviewed our patient database to identify acute ischemic stroke patients who developed dysphagia after stroke but were free of other confounding conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness (LOC), facial weakness, dysarthria, neglect, bihemispheric infarcts, right hemispheric infarcts, brainstem infarcts, intubation, aspiration, acute stroke therapies, occurrence of symptomatic hemorrhagic transformation, seizures, pneumonia, and length of hospitalization (LOH) on persistence of dysphagia at hospital discharge in a logistic regression analysis.
  
  
  RESULTS
  The mean age and NIHSS scores (mean ± standard deviation) were 75.9 ± 13.6 years and 13.5 ± 6.9, respectively; 58.5% were women. In a multivariate analysis, aspiration detected on a clinical swallowing evaluation (odds ratio [OR] 21.83; 95% confidence interval [CI] 8.16-58.42; P < .0001), aspiration on videofluoroscopic swallowing study (OR 10.50; 95% CI 3.35-32.96; P < .0001), bihemispheric infarcts (OR 3.72; 95% CI 1.33-10.43; P = .0123), dysarthria (OR 3.4; 95% CI 1.57-7.35; P = .0019), intubation (OR 2.86; 95% CI 1.10-7.39; P = .0301), NIHSS score ≥12 (OR 2.51; 95% CI 1.19-5.23; P = .0157) were significant predictors of persistent dysphagia. The area under the curve and Somer's Dxy statistics of the model were 0.8918 and 0.78, respectively, indicating good calibration and discriminative power.
  
  
  CONCLUSIONS
  Prognostic factors affecting swallowing recovery identified in this study can help advance dysphagia research methodologies and the clinical care of stroke patients.
authors.affiliation: Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: skumar@bidmc.harvard.edu.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher
authors.initials: C
authors.lastname: Doughty
authors.affiliation: Department of Biostatistics, Boston University, Boston, Massachusetts.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Magdy
authors.initials: M
authors.lastname: Selim
authors.affiliation: Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Sourabh
authors.initials: S
authors.lastname: Lahoti
authors.affiliation: Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Gokhale
authors.affiliation: Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000503:physiopathology*
keywords: Dysphagia; multivariate logistic regression analysis; predictors; prognosis