Early predictors of dysphagia in ischaemic stroke patients

Daniele Mattavelli; Francesco Mele; Ilaria Cova; Silvia Rosa; Pierluigi Bertora; Simone Pomati; Nicole Pizzorni; Antonio Schindler; Leonardo Pantoni

doi:10.1111/ene.15846

Early predictors of dysphagia in ischaemic stroke patients

Eur J Neurol. 2023 Aug;30(8):2324-2337. doi: 10.1111/ene.15846. Epub 2023 May 23.

Authors

Daniele Mattavelli¹, Francesco Mele¹, Ilaria Cova¹, Silvia Rosa¹, Pierluigi Bertora², Simone Pomati¹, Nicole Pizzorni³, Antonio Schindler³, Leonardo Pantoni²

Affiliations

¹ Neurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy.
² Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
³ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.

PMID: 37159487
DOI: 10.1111/ene.15846

Abstract

Background and purpose: Post-stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia.

Methods: Ischaemic stroke patients underwent clinical, cognitive and pre-morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale.

Results: In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05), pre-event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09-1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49-2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82-19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05-2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85-0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95% CI 1.04-1.56), admission NIHSS (OR 1.88, 95% CI 1.56-2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44-32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95-7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83-0.96) and thrombolysis (OR 0.77, 95% CI 0.23-0.95) had a protective role. The 6-point "NOTTEM" (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk.

Conclusions: Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.

Keywords: dysphagia; evaluation; prognosis; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Ischemia* / complications
Deglutition Disorders* / diagnosis
Deglutition Disorders* / etiology
Female
Humans
Ischemic Stroke* / complications
Male
Retrospective Studies
Stroke* / complications
Treatment Outcome