Swallowing Dysfunction after Acute Stroke: The Incidence, Predictors and Outcome

Introduction: Swallowing dysfunction is common after acute stroke. It increases the risk of aspiration pneumonia and affects nutrition. In this study, we aimed to determine the incidence of dysphagia after a single episode of acute stroke in conscious patients and the factors predisposing the patient to dysphagia. We also assessed the course of dysphagia over a period of 8 weeks after stroke.

Materials and methods: It was a prospective observational study. We included patients of acute stroke (ischemic, hemorrhagic, lacunar, anterior, as well as posterior circulation) with Glasgow Coma Scale (GCS) of ≥12; within 48 hours of onset. Patients were screened for dysphagia by the Gugging Swallowing Screen (GUSS) screening tool; then assessed in detail using by Mann Assessment of Swallowing Ability (MASA) scoring scale. Patients with dysphagia were reassessed at 7 days and at 8 weeks after stroke for the presence and severity of dysphagia.

Results: We included 150 patients. The incidence of dysphagia at day 1, day 7, and 8 weeks was 42, 24, and 9%, respectively. The proportion of patients with moderate and severe dysphagia also decreased during a follow-up period of 8 weeks from 18 to 3% and from 20 to 6%, respectively. The incidence of dysphagia was significantly greater in moderately severe stroke [National Institutes of Health Stroke Scale (NIHSS 5-14)] than in mild stroke (NIHSS 1-4). It was also more common in total anterior circulation infarct (TACI) than partial anterior circulation or lacunar infarct (LacI) and in posterior circulation strokes than the strokes involving anterior circulation. Patients with dysphagia had longer hospital stays (7.29 ± 3.4 days vs 3.62 ± 1.5 days, p = 0.001) and higher mean modified Rankin score at discharge (3.45 vs 2.17, p = 0.001).

Conclusion: Swallowing dysfunction should be checked in all cases of strokes, including unilateral hemispheric strokes and in fully conscious patients. Swallowing improves with time, but the patient may require feeding assistance in an acute setting. Dysphagia is more common in strokes with higher NIHSS, involving more brain parenchyma and posterior circulation strokes.