Predictive Factors of Swallowing Disorders and Bronchopneumonia in Acute Ischemic Stroke.
Aged
Aged, 80 and over
Brain Ischemia
/ diagnosis
Bronchopneumonia
/ diagnosis
Deglutition
Deglutition Disorders
/ diagnosis
Dental Prosthesis
/ adverse effects
Enteral Nutrition
/ adverse effects
Female
Hospitalization
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Stroke
/ diagnosis
Time Factors
Swallowing disorders
acute ischemic stroke
bronchopneumonia
dysphagia
predictive factors
speech therapy
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
24
12
2018
revised:
01
03
2019
accepted:
18
04
2019
pubmed:
28
5
2019
medline:
14
8
2019
entrez:
27
5
2019
Statut:
ppublish
Résumé
In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in acute ischemic stroke (AIS) and the risk of BP, as well as to identify factors associated with these conditions. We retrospectively studied all AISs over a 12-month period in a single-center registry. We determined the frequency of SD in the first 7 days and of BP over the entire hospital stay. Associations of SD and BP with patient characteristics, stroke features, dental status, and presence of a feeding tube were analyzed in multivariate analyses. In the 340 consecutive patients, the overall frequency of SD and BP was 23.8% and 11.5%, respectively. The multivariate analyses showed significant associations of SD with NIHSS scores >4, involvement of the medulla oblongata and wearing a dental prosthesis (area under the receiver-operator curve (AUC) of 76%). BP was significantly associated with NIHSS scores >4, male sex, bilateral cerebral lesions, the presence of SD, and the use of an enteral feeding tube (AUC 84%). In unadjusted analysis, unfavorable 12-month outcome and mortality were increased in the presence of SD. In AIS, SD and BP are associated with stroke severity and localization and wearing a dental prosthesis increases the risk of SD. Given that patients with SD have an increased risk of poor outcome and mortality, high-risk patients warrant early interventions, including more randomized trials.
Sections du résumé
BACKGROUND
BACKGROUND
In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in acute ischemic stroke (AIS) and the risk of BP, as well as to identify factors associated with these conditions.
METHODS
METHODS
We retrospectively studied all AISs over a 12-month period in a single-center registry. We determined the frequency of SD in the first 7 days and of BP over the entire hospital stay. Associations of SD and BP with patient characteristics, stroke features, dental status, and presence of a feeding tube were analyzed in multivariate analyses.
RESULTS
RESULTS
In the 340 consecutive patients, the overall frequency of SD and BP was 23.8% and 11.5%, respectively. The multivariate analyses showed significant associations of SD with NIHSS scores >4, involvement of the medulla oblongata and wearing a dental prosthesis (area under the receiver-operator curve (AUC) of 76%). BP was significantly associated with NIHSS scores >4, male sex, bilateral cerebral lesions, the presence of SD, and the use of an enteral feeding tube (AUC 84%). In unadjusted analysis, unfavorable 12-month outcome and mortality were increased in the presence of SD.
CONCLUSION
CONCLUSIONS
In AIS, SD and BP are associated with stroke severity and localization and wearing a dental prosthesis increases the risk of SD. Given that patients with SD have an increased risk of poor outcome and mortality, high-risk patients warrant early interventions, including more randomized trials.
Identifiants
pubmed: 31129105
pii: S1052-3057(19)30194-6
doi: 10.1016/j.jstrokecerebrovasdis.2019.04.025
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2148-2154Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.