Status Of Dysphagia After Ischemic Stroke: A Korean Nationwide Study
Authors
Nayeon Ko ; Hyun Haeng Lee ; Min Kyun Sohn ; Deog Young Kim ; Yong-Il Shin ; Gyung-Jae Oh ; Yang-Soo Lee ; Min Cheol Joo ; So Young Lee ; Min-Keun Song ; Junhee Han ; Jeonghoon Ahn ; Young-Hoon Lee ; Won Hyuk Chang ; Soo Mi Choi ; Seon Kui Lee ; Jongmin Lee ; Yun-Hee Kim
Citation
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, Vol.102(12) : 2343-2352, 2021-12
Aged ; Cohort Studies ; Deglutition Disorders / etiology* ; Disability Evaluation ; Female ; Humans ; Incidence ; Ischemic Stroke / complications* ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires
Keywords
Deglutition disorders ; Rehabilitation ; Stroke
Abstract
Objective: To identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia.
Design: Retrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort.
Setting: Acute care university hospitals.
Participants: Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into 2 groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests.
Interventions: Not applicable.
Main outcome measures: Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), poststroke mRS, and ASHA-NOMS swallowing level at poststroke day 7 were evaluated.
Results: Among patients with ischemic stroke, 32.3% (n=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (n=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI <18.5 kg/m2), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds ratio (OR) for the presence of dysphagia significantly increased with underweight (OR, 1.6684; 95% confidence interval [CI], 1.27-2.20), increased age at onset (OR, 1.0318; 95% CI, 1.03-1.04), premorbid mRS (OR, 1.1832; 95% CI, 1.13-1.24), brainstem lesions (OR, 1.6494; 95% CI, 1.39-1.96), and NIHSS (OR, 1.2073; 95% CI, 1.19-1.23).
Conclusions: The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.