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Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

Published on Feb 10, 2016in PLOS ONE2.776
· DOI :10.1371/journal.pone.0148424
Marcel Arnold53
Estimated H-index: 53
,
Kai Timo Liesirova3
Estimated H-index: 3
+ 7 AuthorsHakan Sarikaya20
Estimated H-index: 20
Sources
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. CONCLUSION Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization.
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  • Citations (62)
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References53
Newest
#1Li LH-Index: 1
#2Li YH-Index: 1
Last. Shi JH-Index: 1
view all 6 authors...
BACKGROUND: Dysphagia is not uncommon after stroke. Dysphagia may delay the functional recovery and substantially affects the quality of life after stroke, mainly if lest untreated. To detect and treat dysphagia as early as possible is critical for patients' recovery after stroke. Electrical stimulation has been reported as a treatment for pharyngeal dysphagia in recent studies, but the therapeutic effects of neuromuscular electrical stimulation (VitalStim®) therapy lacks convincing supporting e...
12 Citations
#1Ryo Momosaki (Jikei University School of Medicine)H-Index: 13
#2Masahiro Abo (Jikei University School of Medicine)H-Index: 23
Last. Kenjiro Mochio (Jikei University School of Medicine)H-Index: 2
view all 6 authors...
Objectives: Recently, the usefulness of neuromuscular electrical stimulation and repetitive transcranial magnetic stimulation for poststroke dysphagia has been reported. However, there is no report that describes the effectiveness of functional magnetic stimulation (FMS) for dysphagia. The purpose of this study is to clarify the effectiveness of FMS for poststroke dysphagia. Methods: Twenty poststroke dysphagic patients (age at treatment: 51–80 years; interval between onset of stroke and treatme...
13 CitationsSource
#1Margaret C. Fang (UCSF: University of California, San Francisco)H-Index: 29
#2Marcelo Coca Perraillon (U of C: University of Chicago)H-Index: 9
Last. Allison B. Rosen (UMMS: University of Massachusetts Medical School)H-Index: 30
view all 5 authors...
Background Stroke is a major cause of morbidity and mortality. We describe trends in the incidence, outcomes, and risk factors for stroke in the US Medicare population from 1988 to 2008.
48 CitationsSource
#1Heather Shaw Bonilha (MUSC: Medical University of South Carolina)H-Index: 13
#2Annie N. Simpson (MUSC: Medical University of South Carolina)H-Index: 7
Last. Kit N. Simpson (MUSC: Medical University of South Carolina)H-Index: 27
view all 6 authors...
With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining ...
28 CitationsSource
#1Emily Brogan (SCGH: Sir Charles Gairdner Hospital)H-Index: 3
#2Claire LangdonH-Index: 4
Last. David Blacker (UWA: University of Western Australia)H-Index: 16
view all 5 authors...
Swallowing problems occur in 37–78 % of stroke patients. Evidence points to multiple factors contributing to the development of pneumonia in the first week post stroke, of which the presence of dysphagia is one. A heightened understanding of the very acute phase (first 7 days post stroke) is required to improve management of this population. We conducted a retrospective review of 536 stroke patients admitted to Australian hospitals in 2010. Data were collected on 37 clinical and demographic para...
30 CitationsSource
#1Marlís González-Fernández (Johns Hopkins University)H-Index: 15
#2Lauren Ottenstein (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 1
Last. Asare B. Christian (Johns Hopkins University)H-Index: 3
view all 4 authors...
Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this popula...
33 CitationsSource
#1Charles Ellis (MUSC: Medical University of South Carolina)H-Index: 18
#2Annie N. Simpson (MUSC: Medical University of South Carolina)H-Index: 12
Last. Kit N. Simpson (MUSC: Medical University of South Carolina)H-Index: 27
view all 5 authors...
With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining ...
63 CitationsSource
#2Jane A. AndersonH-Index: 9
Last. Pamela WillsonH-Index: 7
view all 3 authors...
Background and Purpose—Screening for dysphagia is essential to the implementation of preventive therapies for patients with stroke. A systematic review was undertaken to determine the evidence-based validity of dysphagia screening items using instrumental evaluation as the reference standard. Methods—Four databases from 1985 through March 2011 were searched using the terms cerebrovascular disease, stroke deglutition disorders, and dysphagia. Eligibility criteria were: homogeneous stroke populati...
115 CitationsSource
#1P.C.M.I. Okubo (USP: University of São Paulo)H-Index: 1
#2S.R.C. Fábio (USP: University of São Paulo)H-Index: 1
Last. Osvaldo Massaiti Takayanagui (USP: University of São Paulo)H-Index: 30
view all 4 authors...
Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that
40 CitationsSource
An evidenced-based approach to detecting and treating dysphagia needs to be informed by the costs and risks associated with pneumonia. In this study, the cost of pneumonia during hospitalization after stroke and the effect of pneumonia on mortality were estimated. The effect of pneumonia on mortality and costs for different levels of risk were analyzed as well. The data come from the 2005 and 2006 Nationwide Inpatient Sample. Regression models, including the propensity for pneumonia, were used t...
58 CitationsSource
Cited By62
Newest
#2Michał Jakubczyk (Warsaw School of Economics)H-Index: 10
Last. Maciej Niewada (Medical University of Warsaw)H-Index: 17
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BACKGROUND Dysphagia is a well-known stroke complication characterised by difficulty in swallowing. It may affect the majority of stroke patients and increases mortality and morbidity, due to aspiration pneumonia and malnutrition. Food thickening may help patients to feed themselves, and its effectiveness was demonstrated. However, the cost-effectiveness studies are lacking. We evaluate the cost-utility of xanthan gum-based consistency modification therapy (Nutilis Clear®) in adult post-stroke p...
Source
#1Kathryn Prame Kumar (Monash University, Clayton campus)H-Index: 2
#2Connie Hy Wong (Monash University, Clayton campus)
The composition of the gut microbiota depends on many factors, including our lifestyle, diet, metabolism, antibiotic use and hygiene. The contribution of these factors in shaping the gut microbiota and the subsequent effects on the prevention and development of stroke has been under intense investigation. Furthermore, several reports have uncovered the impact of stroke on intestinal dysfunction and gut dysbiosis, highlighting the delicate interplay between the brain, gut and microbiome following...
Source
Background There have been many scales to predict pneumonia in stroke patients, but they are so complex, making it difficult to apply in practice. Therefore, we conducted this study to assess the role of the National Institutes of Health Stroke Scale (NIHSS) and the Gugging Swallowing Screen (GUSS) in predicting stroke-associated pneumonia (SAP). These scales are routinely used in stroke patients. Therefore, their application in predicting SAP risk will be of high value in clinical practice. The...
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#1Laura L. Pitts (NU: Northwestern University)H-Index: 2
#2Lynn M. Rogers (NU: Northwestern University)H-Index: 8
Last. Leora R. Cherney (NU: Northwestern University)H-Index: 24
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ABSTRACTBackground: Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) direct...
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Abtsract Objective To investigate the incremental prognostic significance of malnutrition in patients with severe post-stroke disability. Design Retrospective cohort study. The patients were recruited from three specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI) that is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutritional status, scores of 35-to-38 moderate malnutrition, s...
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#2Athanase Millogo (French Institute of Health and Medical Research)
Last. Jean-Claude Desport (French Institute of Health and Medical Research)H-Index: 18
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Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional paramet...
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#1Stefan Knecht (HHU: University of Düsseldorf)H-Index: 59
#2T. Schmidt-Wilcke (HHU: University of Düsseldorf)
Die Neurorehabilitation versorgt oft Patienten, die schwer und mehrfach erkrankt sind und haufig zuvor durch nichtneurologische Fachdisziplinen behandelt wurden. Medizinisch sind diese Patienten oft noch instabil, sodass die bisherige Diagnostik und Therapien neu bewertet und gegebenenfalls adaptiert oder erganzt werden mussen. Bestimmte, auch die Neurologie uberschreitende diagnostische und therapeutische Probleme – haufig zu antithrombotischer Therapie – tauchen dabei immer wieder auf. Diese w...
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#1Maria Schwarz (UQ: University of Queensland)H-Index: 1
#2Anne Coccetti (Logan Hospital)H-Index: 1
Last. Elizabeth Cardell (Griffith University)H-Index: 7
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Objective: Decision-making around dysphagia management is becoming increasingly challenging due to the complexity of contexts associated with an ageing population. The current study explores current decision-making practices used by speech language therapists (SLTs) surrounding contexts related to palliative care, dementia, neuro-degenerative diseases, guardianship/family decisions, and other issues relevant to ongoing care of individuals with dysphagia. Methods: An exploratory prospective elect...
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#1Arlene McCurtin (UL: University of Limerick)H-Index: 5
#2Pauline Boland (UL: University of Limerick)H-Index: 4
Last. Rose Galvin (UL: University of Limerick)H-Index: 25
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RATIONALE: Aspiration is a common sequela post stroke as a result of oropharyngeal dysphagia. It is primarily managed using the poorly empirically supported intervention of thickened liquids. Where evidence is limited, clinicians may rely on clinical practice guidelines to support decision making. The purpose of this systematic review and narrative synthesis was to evaluate the evidentiary bases of recommendations made by stroke clinical practice guidelines regarding the thickened liquids interv...
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BACKGROUND: The effects of swallowing therapy (ST) on long-term clinical outcomes in patients with post-stroke dysphagia (PSD) remain unclear. AIM: This study explores the effect of ST, initiated within 6 months of the stroke onset, on long-term pneumonia-free and overall survival rates in PSD patients. DESIGN: Retrospective cohort study. SETTING: Longitudinal Health Insurance Database. POPULATION: The study included 2994 eligible PSD patients between 2005 and 2013. METHODS: Among the scrutinize...
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