title: Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes.
abstract: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes.
  
  
  
  Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability.
  
  
  
  Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2).
  
  
  
  Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.
authors.affiliation: Department of Neurology, University of Lx00FC;beck, Lx00FC;beck, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Khaled
authors.forename: Christine
authors.initials: C
authors.lastname: Matthis
authors.forename: Andreas
authors.initials: A
authors.lastname: Binder
authors.forename: Jonas
authors.initials: J
authors.lastname: Mudter
authors.forename: Joern
authors.initials: J
authors.lastname: Schattschneider
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pulkowski
authors.forename: Tim
authors.initials: T
authors.lastname: Strohmaier
authors.forename: Torsten
authors.initials: T
authors.lastname: Niehoff
authors.forename: Roland
authors.initials: R
authors.lastname: Zybur
authors.forename: Juergen
authors.initials: J
authors.lastname: Eggers
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valdueza
authors.forename: Georg
authors.initials: G
authors.lastname: Royl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors