COMPLICATIONS AND OUTCOME AFTER ACUTE STROKE - DOES DYSPHAGIA MATTER

Background and Purpose The published data on the relationship between dysphagia and both outcome and complications after acute stroke have b een inconclusive. We examined the relationship between these, using be dside assessment and videofluoroscopic examination. Methods We prospec tively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We perfo rmed videofluoroscopy blinded to this assessment within 3 days of stro ke onset and within a median time of 24 hours of the bedside evaluatio ns. The presence of aspiration was recorded. Mortality, functional out come, length of stay, place of discharge, occurrence of chest infectio n, nutritional status, and hydration were the main outcome measures. R esults Patients with an abnormal swallow (dysphagia) on bedside assess ment had a higher risk of chest infection (P=.05) and a poor nutrition al state (P<.001). The presence of dysphagia was associated with an in creased risk of death (P=.001), disability (P=.02), length of hospital stay (P<.001), and institutional carl (P<.05). When other factors wer e taken into account, dysphagia remained as an independent predictor o f outcome only with regard to mortality. The use of videofluoroscopy i n detecting aspiration did not add to the value of bedside assessment. Conclusions Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine sc reening with videofluoroscopy to detect aspiration is questioned.