Swallowing Disorders following Acute Stroke: Prevalence and Diagnostic Accuracy

Abstract

We prospectively examined 128 patients with acute first-ever stroke to determine the prevalence of swallowing disorders, the diagnostic accuracy of our clinical assessment of swallowing function compared with videofluoroscopy, and interobserver agreement for the clinical and videofluoroscopic diagnosis of swallowing disorders and aspiration. We found clinical and videofluoroscopic evidence of a swallowing disorder in 51% [95% confidence interval (CI) 42–60%] and 64% (95% CI 55–72%) of patients, respectively, and aspiration in 49% (95% CI 40–58%) and 22% (95% CI 15–29%) of patients, respectively. The optimal clinical criteria for detecting videofluoroscopic evidence of a swallowing disorder and aspiration were any clinical evidence of a swallowing disorder (sensitivity 73%, 95% CI 62–82%; specificity 89%, 95% CI 76–96%), and any clinical evidence of aspiration (sensitivity 93%, 95% CI 76–99%; specificity 63%, 95% CI 53–72%). The interobserver agreement between two speech pathologists for the clinical diagnosis of a swallowing disorder (κ: 0.82 ± 0.09) and aspiration (κ: 0.75 ± 0.09) was good, and between a speech pathologist and radiologist for the videofluoroscopic diagnosis of a swallowing disorder (κ: 0.75 ± 0.09) and aspiration (κ: 0.41 ± 0.09), it was good and fair, respectively. Although clinical bedside examination underestimates the frequency of swallowing abnormalities and overestimates the frequency of aspiration compared with videofluoroscopy, it may still offer valuable information for the diagnosis of swallowing impairment. Long-term follow-up studies are required to determine the independent functional significance of the findings of the bedside and videofluoroscopic examinations in predicting the occurrence of important outcome events such as aspiration pneumonia.

Risk factors for swallowing dysfunction in stroke patients

“…The prevalence of oropharyngeal dysphagia in patients with stroke reported in the literature varies widely from 23% to 91% (3,5,15,22,23,27,29,34,45) . This variation may be explained by the methods applied in the various studies, by the different severity and by the difference in the time of evaluation of patients with stroke.…”

Dysphagia and Respiratory Infections in Acute Ischemic Stroke

“…Using a combination of videofluoroscopy and bedside swallowing examination, Mann, Hankey & Cameron (2000) reported that aspiration was present in 49% of a cohort of 128 acute stroke patients. By six months post stroke, 97 of 112 survivors had returned to their pre-stroke diet (Mann, Hankey & Cameron, 1999).…”

Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

“…Stroke has been reported to be associated with dysphagia, the incidence of which range from 23 to 50 % [16][17][18][19][20][21][22][23][24]. Increased risk of aspiration pneumonia, dehydration and malnutrition have been reported in stroke patients as a consequence of dysphagia [25][26][27][28].12 of our patients had middle cerebral artery infarct showing the symptoms of aphasia(4 with Brocas aphasia and 8 with global aphasia).Eight of them had severe dysphagia and two of them had moderate dysphagia.…”