ASPIRATION AND RELATIVE RISK OF MEDICAL COMPLICATIONS FOLLOWING STROKE

Objective: To determine the relative risk of pneumonia, dehydration, a nd death associated with videofluoroscopic evidence of aspiration, sil ent aspiration, aspiration of 10% or greater on one or more barium tes t swallows, and aspiration of thick liquid or more solid consistencies in the subacute phase after stroke. Design: Prospective, longitudinal cohort study. Setting: Inpatient stroke rehabilitation unit. Patients : There were 114 consecutive patients who met the following criteria: (1) stroke as defined by clinical history and neurological examination with compatible computed tomographic or magnetic resonance imaging sc an; (2) age 20 to 90 years, inclusive; (3) no known history of signifi cant oropharyngeal anomaly, and (4) videofluoroscopic evidence of dysp hagia. Of 122 eligible patients, eight refused participation. Main Out come Measures: Development of pneumonia, dehydration, and death. Resul ts: The relative risk for developing pneumonia was 6.95 times greater (P=.027) for those patients who aspirated compared with those who did not, 5.57 times greater (P=.012) for those who aspirated silently comp ared with those who coughed when aspirating or who did not aspirate, a nd 8.36 times greater (P=.002) for those who aspirated 10% or greater on one or more barium test swallows compared with those who aspirated less than 10% or did not aspirate. Conclusion: Aspiration, silent aspi ration, and aspiration of 10% or greater on one or more barium test sw allows during videofluoroscopic evaluation are associated with an incr eased risk of pneumonia, but not dehydration or death, during the suba cute phase after stroke.