title: Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke.
abstract: BACKGROUND
  The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients.
  
  
  METHODS
  This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05.
  
  
  RESULTS
  The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly.
  
  
  CONCLUSIONS
  There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.
authors.affiliation: Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil. Electronic address: priwtr@yahoo.com.br.
authors.forename: Priscila W
authors.initials: PW
authors.lastname: Ribeiro
authors.affiliation: Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil.
authors.forename: Paula C
authors.initials: PC
authors.lastname: Cola
authors.affiliation: Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Gatto
authors.affiliation: Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil.
authors.forename: Roberta G
authors.initials: RG
authors.lastname: da Silva
authors.affiliation: Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Luvizutto
authors.affiliation: Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Braga
authors.affiliation: Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
authors.forename: Arthur O
authors.initials: AO
authors.lastname: Schelp
authors.affiliation: Department of Surgery, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
authors.forename: Maria A C
authors.initials: MA
authors.lastname: de Arruda Henry
authors.affiliation: Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bazan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.) / Q000592:standards; D009460:Neurologic Examination; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013070:Speech Therapy; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D014481:United States
keywords: Stroke; deglutition; deglutition disorders; dysphagia; neurologic impairment; pneumonia predictors