Dysphagia affected more than one third (38.8%) of acute stroke patients assessed with the GUSS by a speech-language pathologist, and was associated with greater stroke severity, extended hospitalisation, and adverse discharge outcomes.
Key Findings
Results
The incidence of dysphagia in the acute phase after stroke was 38.8% among 1,093 consecutive patients assessed with a standardized swallowing screen.
Patients were consecutive acute stroke admissions at four Swedish stroke units, part of the DESIRE multicentre prospective study.
Dysphagia was assessed within 96 h of stroke onset using the Gugging Swallowing Screen (GUSS) administered by a speech-language pathologist.
The cohort comprised 1,093 patients (468 women, 42.8%; median age 75 years).
Results
Dysarthria was an independent predictor of post-stroke dysphagia.
Adjusted odds ratio (aOR) 1.85, CI = 1.32-2.59, p < 0.001.
Estimated from multivariable regression models.
Results
Greater stroke severity was independently associated with dysphagia.
aOR 1.16, CI = 1.12-1.19, p < 0.001.
Identified through multivariable regression adjusted for other dysphagia risk factors.
Results
Female sex and infratentorial lesions were independently associated with higher odds of dysphagia.
Female sex: aOR 1.39, CI = 1.00-1.92, p = 0.047.
Infratentorial lesions: aOR 2.01, CI = 1.10-3.69, p = 0.024.
Results
Older age was an independent predictor of dysphagia.
Reported with p < 0.001 in the multivariable model.
Median age of the cohort was 75 years.
Results
Dysphagia was associated with a longer hospital stay.
Ratio of means 1.64, CI = 1.36-1.98, p < 0.001.
Hospital stay data were prospectively collected.
Results
Dysphagia was associated with markedly higher odds of adverse discharge outcomes, including discharge to nursing homes, short-term care facilities, and in-hospital death.
Nursing home discharge: aOR 4.84, CI = 2.46-9.56, p < 0.001.
Short-term care facility discharge: aOR 4.69, CI = 1.87-11.76, p < 0.001.
In-hospital death: aOR 16.67, CI = 2.10-132.05, p = 0.008 (wide confidence interval).
Background
The study addressed uncertainty in dysphagia incidence caused by heterogeneous and non-validated assessment methods in prior literature.
Prior estimates vary widely due to heterogeneous assessment methods and limited use of standardized, validated evaluations.
Dysphagia is frequently underestimated despite associations with mortality, morbidity, and pneumonia-related hospitalisation.
Clinical data on stroke characteristics, risk factors, pneumonia incidence, and discharge destination were prospectively collected.
What This Means
This study followed 1,093 people admitted with an acute stroke to four Swedish stroke units. A speech-language pathologist tested each person's swallowing within four days of the stroke using a standard screening tool (the Gugging Swallowing Screen). About 39% of patients had swallowing difficulty (dysphagia), meaning more than one in three.
Swallowing problems were more likely in people with more severe strokes, slurred speech (dysarthria), strokes in the lower part of the brain (infratentorial), older age, and women. People with dysphagia stayed in hospital about 64% longer on average. They were also much more likely to be discharged to a nursing home or short-term care facility, or to die in hospital, although the estimate for in-hospital death was based on few cases and is imprecise.
This research suggests that swallowing difficulty is common after stroke and is linked to worse outcomes, supporting early, standardized swallowing assessment in stroke care. The study shows associations and does not prove that dysphagia itself causes the worse outcomes, since it may partly reflect more severe strokes.