Incidence and Risk Factors for Dysphagia Following Non-traumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study.

Abstract

The aim of the study is to investigate dysphagia incidence and establish factors which may reliably predict dysphagia risk in individuals presenting with non-traumatic subarachnoid hemorrhage (SAH). A retrospective chart audit of 250 patients (151 females and 99 males) consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral center in Australia was conducted. Demographics, medical, and surgical information, along with speech-language pathology (SLP) assessment data were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t tests, χ2, and Fisher's exact tests. Univariate and multivariate logistic regression analysis was performed to establish factors associated with dysphagia risk. A total of 31.6% of participants were identified with dysphagia during acute inpatient admission based on SLP, medical officer, and/or nursing staff reports. Individuals with dysphagia had significantly (p < 0.01) higher World Federation of Neurological Surgeons (WFNS) grading scores, were more likely to have an aneurysmal cause, were more likely to have secondary complications such as vasospasm, hydrocephalus, or new ischemia, were older, and had longer intubation and intensive care unit (ICU) periods than those without dysphagia. Dysphagia risk was significantly associated (p < 0.01) with age > 57.5years, ICU length of stay > 7.5days, length of intubation > 1.5days, need for tracheostomy, vasospasm, and new stroke. Dysphagia is highly prevalent following non-traumatic SAH, and significantly associated with a number of factors. Established risk factors will improve current knowledge, promote early identification of dysphagia, and inform SLP referral criteria and management of this patient cohort.