title: Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome.
abstract: BACKGROUND
  Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke.
  
  
  METHODS
  We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia.
  
  
  RESULTS
  Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, p<0.001), stayed longer at monitored stroke unit beds (4.4±2.8 vs. 2.7±2.4 days; p<0.001) and were less often discharged to home (19.5% vs. 63.7%, p = 0.001) as compared to those without dysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; p<0.001), less often lived at home (38.8% vs. 76.5%; p<0.001), and more often had died (13.6% vs. 1.6%; p<0.001). Multivariate analyses identified dysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality.
  
  
  CONCLUSIONS
  Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization.
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Marcel
authors: M
authors: Arnold
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Kai
authors: K
authors: Liesirova
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Anne
authors: A
authors: Broeg-Morvay
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Julia
authors: J
authors: Meisterernst
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Markus
authors: M
authors: Schlager
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Marie-Luise
authors: ML
authors: Mono
authors: Department of Neuroradiology, University Hospital of Berne, Berne, Switzerland.
authors: Marwan
authors: M
authors: El-Koussy
authors: Department of Neurology and Neurophysiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors: Georg
authors: G
authors: Kägi
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Simon
authors: S
authors: Jung
authors: Department of Neurology, University Hospital of Berne, Berne, Switzerland.
authors: Hakan
authors: H
authors: Sarikaya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications* / Q000453:epidemiology; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011015:Pneumonia, Aspiration / Q000150:complications; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D055815:Young Adult