Bedside Dysphagia screening evaluation in acute stroke patients.

BACKGROUND AND OBJECTIVES: Dysphagia is a common problem after stroke and has been identified as an independent predictor of morbidity and mortality. This study was aimed to determine the incidence of dysphagia and associated pulmonary compromise and morbidity in patients with acute stroke. To the authors' knowledge, there is no published local study evaluating the correlation of dysphagia and clinical outcomes in acute stroke.

Study Design: Descriptive, Retrospective study

METHODS: Data was extracted, collated, and presented descriptively. All patients with acute stroke admitted either to the Acute Stroke Unit (ASU) or Neurocritical Care Unit (NCCU). within the period of May 2006 to February 2009 who underwent a bedside Dysphagia Screening test were included. Data on demographic characteristics, co morbid conditions, stroke tone and location, GCS on admission, presence of pneumonia, and length of hospital stay were obtained from hospital charts. RESULTS: A total of 560 patients underwent dysphagia screening during the study period. Of these, 316 (56.4%) had an acute stroke. Seventy-one patients (22%) failed in the dysphagia screening or were found to be at risk for dysphagia while 245 (78%) passed the evaluation. Patients who failed in the dysphagia screening had a significantly longer average length of stay (ALOS) of 26 days as opposed to 12 days ALOS of those who passed. Those who failed had a significantly higher rate of developing pneumonia (19.7%) as compared to those who passed (2.4%). Linear regression analysis showed that having impaired voice (p=0.006), flattened nasolabial fold (p<0.001) and asymmetrical soft palate elevation (p<0.0001) showed significant relationship with the presence of pneumonia.

CONCLUSIONS: Dysphagia is a common problem encountered after an acute stroke and predisposes a patient to a higher risk of developing pulmonary morbidity and longer hospital stay. Patients who failed in dysphagia screening were found to have a significantly longer average length of hospital stay and a higher rate of developing pneumonia as compared to those who passed. The presence of impaired voice, flattened nasolabial fold and asymmetrical soft palette elevation showed significant correlation with the development of pneumonia.