The Contribution of Dysphagia to Acute Stroke Morbidity and Mortality in Nigeria: A Prospective Study

Authors

  • OO Olajide
  • PB Adebayo
  • FT Taiwo
  • MO Owolabi
  • A Ogunniyi

DOI:

https://doi.org/10.30442/ahr.0702-04-123

Keywords:

Acute Stroke, Aspiration pneumonia, Dysphagia, Screening, Water Swallowing Test

Abstract

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without dysphagia) in terms of stroke characteristics and 30-day outcome.

Results: Of the recruited 200 patients, 99 (49.5%) had dysphagia. Patients with intracerebral haemorrhagic stroke had a significantly higher prevalence of dysphagia (64% vs 36%; p<0.001). At baseline, dysphagic patients had more severe (Mean NHISS score, 22.81 Vs 8.92; p=0.01) and subcortical strokes (57.1% vs 42.9%, p = 0.015). At 30 days after stroke, the mean MRS was significantly higher in the dysphagic stroke patients (3.8±1.02) compared to those without dysphagia (2.5±1.3), (p = 0.001)]. Case fatality was higher among the dysphagic (79.8% vs 15.84%; p = 0.001) and the mean survival time was lower (12.21 days) among the dysphagic group (p = 0.001)

Conclusion: Severe stroke, subcortical stroke and haemorrhagic stroke types were significantly associated with dysphagia at baseline. Dysphagia adversely influenced 30-days morbidity and case fatality in this cohort of acute stroke patients.

References

Owolabi MO, Sarfo F, Akinyemi R, Gebregziabher M, Akpa O, Akpalu A; SIREN Team; as part of H3Africa Consortium. Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): A case-control study. Lancet Glob Health 2018; 6: e436-e446. https://doi.org/10.1016/S2214-109X(18)30002-0

Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, et al. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr 2015; 26(2 Suppl 1): S27-S38. https://doi.org/10.5830/CVJA-2015-038

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763. https://doi.org/10.1161/01.STR.0000190056.76543.eb

Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis 2014; 23: 712-716. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.030

Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F. Gastrointestinal complications after ischemic stroke. J Neurol Sci 2014; 346: 20-25. https://doi.org/10.1016/j.jns.2014.08.027

Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database Syst Rev 2018; 10: CD000323. https://doi.org/10.1002/14651858.CD000323.pub3

Benfield JK, Everton LF, Bath PM, England TJ. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta-analysis. J Clin Nurs 2020; 29: 1527-1538. https://doi.org/10.1111/jocn.15192

Santos KW, Scheeren B, Maciel AC, Cassol M. Vocal Variability Post Swallowing in Individuals with and without Oropharyngeal Dysphagia. Int Arch Otorhinolaryngol 2015; 19: 61-66. https://doi.org/10.1055/s-0034-1394129

Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol 2006; 5: 603-612. https://doi.org/10.1016/S1474-4422(06)70495-1

Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38: 2948-2952. https://doi.org/10.1161/STROKEAHA.107.483933

Nishiwaki K, Tsuji T, Liu M, Hase K, Tanaka N, Fujiwara T. Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables. J Rehabil Med 2005; 37: 247-251. https://doi.org/10.1080/16501970510026999

Turner-Lawrence DE, Peebles M, Price MF, Singh SJ, Asimos AW. A feasibility study of the sensitivity of emergency physician Dysphagia screening in acute stroke patients. Ann Emerg Med 2009; 54: 344-348. https://doi.org/10.1016/j.annemergmed.2009.03.007

Toscano M, Viganò A, Rea A, Verzina A, Sasso D'Elia T, Puledda F, et al. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. Eur J Neurol 2019; 26: 596-602. https://doi.org/10.1111/ene.13862

Yang Y, Wang A, Zhao X, Wang C, Liu L, Zheng H, et al. The Oxfordshire Community Stroke Project classification system predicts clinical outcomes following intravenous thrombolysis: a prospective cohort study. Ther Clin Risk Manag 2016; 12: 1049-1056. https://doi.org/10.2147/TCRM.S107053

Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post-stroke: a systematic review of randomised controlled trials. Age Ageing 2008; 37: 258-264. https://doi.org/10.1093/ageing/afn064

Brodsky MB, Suiter DM, González-Fernández M, Michtalik HJ, Frymark TB, Venediktov R, et al. Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis. Chest 2016; 150: 148-163. https://doi.org/10.1016/j.chest.2016.03.059

Bours GJ, Speyer R, Lemmens J, Limburg M, de Wit R. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: a systematic review. J Adv Nurs 2009; 65: 477-493. https://doi.org/10.1111/j.1365-2648.2008.04915.x

Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke 2012; 43: 892-897. https://doi.org/10.1161/STROKEAHA.111.640946

Sundar U, Pahuja V, Dwivedi N, Yeolekar ME. Dysphagia in acute stroke: correlation with stroke subtype, vascular territory and in-hospital respiratory morbidity and mortality. Neurol India 2008; 56: 463-470. https://doi.org/10.4103/0028-3886.44828

Khedr EM, Abbass MA, Soliman RK, Zaki AF, Gamea A. Post-stroke dysphagia: frequency, risk factors, and topographic representation: a hospital-based study. Egypt J Neurol Psychiatry Neurosurg 2021; 57: 23. https://doi.org/10.1186/s41983-021-00281-9

Fernández-Pombo A, Seijo-Raposo IM, López-Osorio N, Cantón-Blanco A, González-Rodríguez M, Arias-Rivas S, et al. Lesion location and other predictive factors of dysphagia and its complications in acute stroke. Clin Nutr ESPEN 2019; 33: 178-182. https://doi.org/10.1016/j.clnesp.2019.05.019

Suntrup S, Warnecke T, Kemmling A, Teismann IK, Hamacher C, Oelenberg S, et al. Dysphagia in patients with acute striatocapsular haemorrhage. J Neurol 2012; 259: 93-99. https://doi.org/10.1007/s00415-011-6129-3

Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006; 82: 383-391. https://doi.org/10.1136/pgmj.2005.043281

Michou E, Hamdy S. Cortical input in control of swallowing. Curr Opin Otolaryngol Head Neck Surg 2009 ; 17: 166-171. https://doi.org/10.1097/MOO.0b013e32832b255e

Gonzalez-Fernandez M, Kleinman JT, Ky PK, Palmer JB, Hillis AE. Supratentorial regions of acute ischemia associated with clinically important swallowing disorders: a pilot study. Stroke 2008; 39: 3022-3028. https://doi.org/10.1161/STROKEAHA.108.518969

Kim JH, Oh SH, Jeong HJ, Sim YJ, Kim DG, Kim GC. Association between duration of dysphagia recovery and lesion location on Magnetic Resonance Imaging in patients with middle cerebral artery infarction. Ann Rehabil Med 2019; 43: 142-148. https://doi.org/10.5535/arm.2019.43.2.142

Jeyaseelan RD, Vargo MM, Chae J. National Institute of Health Stroke Scale (NIHSS) as an early predictor of poststroke dysphagia. PM R 2015; 7: 593-598. https://doi.org/10.1016/j.pmrj.2014.12.007

Okubo PC, Fábio SR, Domenis DR, Takayanagui OM. Using the National Institute of Health Stroke Scale to predict dysphagia in acute ischemic stroke. Cerebrovasc Dis 2012; 33: 501-507. https://doi.org/10.1159/000336240

Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke 2011; 42: 3214-3218. https://doi.org/10.1161/STROKEAHA.110.610881

Saposnik G, Hill MD, O'Donnell M, Fang J, Hachinski V, Kapral MK, Registry of the Canadian Stroke Network for the Stroke Outcome Research Canada (SORCan) Working Group. Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke 2008; 39: 2318-2324. https://doi.org/10.1161/STROKEAHA.107.510362

Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML, et al. Dysphagia in acute stroke: Incidence, burden and impact on clinical outcome. PLoS One 2016; 11: e0148424. https://doi.org/10.1371/journal.pone.0148424

Feng MC, Lin YC, Chang YH, Chen CH, Chiang HC, Huang LC, et al. The mortality and the risk of aspiration pneumonia related with dysphagia in stroke patients. J Stroke Cerebrovasc Dis 2019; 28: 1381-1387. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.011

Suda S, Aoki J, Shimoyama T, Suzuki K, Sakamoto Y, Katano T, et al. Stroke-associated infection independently predicts 3-month poor functional outcome and mortality. J Neurol 2018; 265: 370-375. https://doi.org/10.1007/s00415-017-8714-6

Teh WH, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand 2018; 138: 293-300. https://doi.org/10.1111/ane.12956

Vermeij FH, Scholte op Reimer WJ, de Man P, van Oostenbrugge RJ, Franke CL, de Jong G, (Netherlands Stroke Survey Investigators), et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey. Cerebrovasc Dis 2009; 27: 465-471. https://doi.org/10.1159/000210093

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Published

2021-05-28

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Original Research