Background
In stroke patients, early complications such as swallowing disorders (SD) and
bronchopneumonia (BP) are reported to be frequent and may worsen outcome. The aim of
this study was to evaluate the prevalence of SD in patients with acute ischemic stroke during
the 7 first days of their hospitalisation and their risk of BP, and to try to identify early
predictors for these conditions.
Methodology
A retrospective study evaluating patients suffering from acute ischemic stroke, admitted to
the Stroke Unit of Lausanne (Switzerland) during one year or the year 2015. In this unit, each
patient undergoes a standardised protocol for early detection of SD. The following factors
have been analysed: demographic characteristics, stroke features, dental status, presence of
a feeding tube, SD and BP, and mortality rate.
Results
Out of 343 patients (157 women, mean age 72±14), SD were identified early in 81 patients
(23.6%); 24 (29.6%) patients with SD and 15 (5.7%) without SD developed BP. SD were more
frequently seen in patients suffering from an anterior stroke, or a more severe stroke, or with
cardio-embolic stroke. When we compared patients with and without SD, the SD group more
frequently had a dental prosthesis (16.1% vs 3.8%) or a feeding tube (55.6% vs 4.2%).
SD associated with BP were more frequently seen in patients with a posterior stroke or with
simultaneous anterior and posterior strokes. They had a higher NIHSS score (14.6±8.5 SD),
more dental prostheses (4, 16.7%) and more feeding tubes (18, 75.0%).
The multivariate analysis demonstrates that the association of a NIHSS score above 4, bulbar
stroke and wearing a dental prosthesis can predict 76% of patients with SD. The association
of a NIHSS score greater than 4, male sex, bilateral hemispheric lesions, an enteral feeding
tube and SD can predict 84% of the risk of BP.
Conclusion
We have identified some independent predictive factors that can significantly increase the risk
of SD and of BP after an ischemic stroke. Their early identification could predict these
complications, and lead to prevent them by earlier management by a speech therapist and
monitoring of respiratory function.