Abstract
BackgroundDiagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients.MethodsThe FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry.ResultsWe investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage.Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6–17] vs. 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities.A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011).ConclusionDue to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre.FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.
Highlights
Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients
The patients with signs of dysphagia were discussed among the “dysphagia experts” of our department and indication for FEES was confirmed; oral diet prior to FEES was chosen as instructed by the Gugging Swallowing Screen (GUSS) or by clinical judgement of the treating physician
In order to prevent data distortion, only the results of the first examination were included in the analysis of patients who received more than one FEES. 94 patients (61.8%) were male and the overall median age was 73 years (IQR 61.25–81 years). 119 patients were older than 60 years (78.3%). 125 patients (82.2%) were diagnosed with ischemic stroke and 27 (17.8%) with primary haemorrhage. patients (48.8%) were treated on the intensive care unit. patients (40.8%, or 26.8% when excluding intensive care patients) were diagnosed with pneumonia and 8 patients (5.3%) died during hospitalisation
Summary
Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. Dysphagia occurs in the course of many neurological diseases and frequently determines the outcome [1] with stroke being the most common cause. Pneumonia due to dysphagia is the leading cause of death in stroke patients [3]. Hyperthermia, that can be caused by the pneumonia-associated fever, is known to be associated with a worse functional outcome in stroke [4]. Another known factor associated with a worse outcome in stroke patients is new or pre-existing malnutrition, which can be caused by dysphagia [5]. Dysphagia is an independent predictor of disability and poor outcome, increased mortality, morbidity and markedly reduced quality of life in stroke [8–11]. Dysphagia leads to further complications in stroke patients, but its resultant long-term healthcare costs underline its socioeconomic relevance [6, 7]
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