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Kim, Oh, Lee, Lee, Chun, and Han: Clinical Factors Associated with Severity of Post-stroke Dysphagia
Original Article
Brain & Neurorehabilitation

Brain & Neurorehabilitation 2011; 4(2): 116-120.

Published online: 30 September 2011

DOI: https://doi.org/10.12786/bn.2011.4.2.116

Clinical Factors Associated with Severity of Post-stroke Dysphagia

Juyong Kim, M.D., Byung-Mo Oh, M.D., Ph.D., Goo Joo Lee, M.D., Seung Ah Lee, M.D.1, Se Woong Chun, M.D., Tai Ryoon Han, M.D., Ph.D.

Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea.

1Department of Rehabilitation Medicine, Konkuk University Medical Center, Korea.

Corresponding author (keepwiz@naver.com)

Received 31 January 2011       Accepted 4 April 2011

Copyright © 2011 Korean Society for Neurorehabilitation

Abstract

Objective

To describe factors associated with the severity of post-stroke dysphagia.

Methods

We reviewed retrospectively medical records of patients having dysphagia following stroke in Seoul National University hospital from April 2002 through Dec 2009. A total of 578 patients (male and female, 331 and 247) were included. The following parameters were recorded and analyzed: patient's sex, age, type of stroke, onset of dysphagia, location of lesion and the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS). Using Binary logistic regression and multiple regression analysis, the relationship between dysphagia severity and other factors were analyzed.

Results

Their average duration between onset of stroke and the date of videofluoroscopic swallowing study (VFSS) was 32.3 ± 18.4 days. Patients with hemorrhagic stroke (172 patients, ASHA 4.06 ± 1.98) showed poorer swallowing function than those with ischemic stroke (406 patients, ASHA 4.49 ± 2.02, p=0.013). Binary logistic regression analysis showed that patients who had longer duration from onset to the first study, hemorrhagic stroke, bilateral lesion and older age were at higher risk for dysphagia requiring non-oral supplements (p=0.031, 0.039, 0.042, and 0.043, respectively). Multiple regression analysis revealed that longer duration from onset to study, older age and hemorrhagic stroke were associated with the lower ASHA NOMS (p=0.006, 0.009 and 0.021, respectively). Bilateral lesion, sex, history of previous stroke and involvement of the brainstem, however, were not significant factors.

Conclusion

Hemorrhagic stroke, longer duration from stroke onset to the initial evaluation, and older age were identified as associated factors with the poorer swallowing function after stroke. Further prospective studies will be required to evaluate the prognostic value of these characteristics.

Keywords: deglutition, dysphagia, regression analysis, stroke

Figures and Tables

Table 1
Basic Characteristics of Subjects
bn-4-116-i001

*Values are mean ± standard deviation.

Table 2
American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale
bn-4-116-i002

PEG: percutaneous endoscopic gastrostomy.

Table 3
Clinical Characteristics and ASHA NOMS
bn-4-116-i003

Values are mean ± standard deviation. ASHA NOMS: American Speech-Language-Hearing Association National Outcome Measurement System, *p value of the Spearman rank correlation, †p value of the Mann-Whitney test.

Table 4
Multiple Logistic Regression of Significant Clinical Factors for Oral Feeding in Dysphagic Stroke Patients
bn-4-116-i004

OR: odds ratio, 95% CI: 95% confidence interval.

Table 5
Multiple Regression Analysis on Clinical Factors for Severity of Dysphagia in Stroke Patients
bn-4-116-i005

OR: odds ratio, 95% CI: 95% confidence interval.

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