Abstract
BackgroundDespite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome.MethodsThis is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome.ResultsTwo-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47–67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4–5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35–7.93), blood stream infection (OR = 4.3, 95% CI = 2.0–9.4), longer ICU stay [14 (8–21) days versus 29.5 (23–45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49–6.39).ConclusionsDysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment.
Highlights
Despite the advances in the clinical management, subarachnoid hemorrhage (SAH) is still associated with a high mortality rate and substantial morbidity [1]
The incidence of swallowing disorders has been extensively studied in ischemic stroke patients, little is known about the true incidence of dysphagia in SAH patients and its contribution to the clinical course and outcome
The main findings were that (1) dysphagia was diagnosed in every third SAH patient, including patients admitted in good clinical grade, that (2) dysphagia was associated with radiographic and clinical disease severity on admission, and (3) that dysphagia was strongly associated with hospital complications, prolonged intensive care unit (ICU) stay, and poor functional outcome
Summary
Despite the advances in the clinical management, subarachnoid hemorrhage (SAH) is still associated with a high mortality rate and substantial morbidity [1]. Patient and disease-specific factors such as initial disease severity, hospital complications as well as the need for prolonged ventilation contribute to longer intensive care unit (ICU) stays and poor functional outcome [1,2,3]. The cerebellum and the brainstem, are involved in the processing of afferent stimuli, initiating the voluntary oral phase of swallowing and coordinating consecutive reflexive mechanisms [5,6,7] All of those regions may incur functional impairment or structural damage through mechanisms of early and secondary brain injury, as well as global cerebral dysfunction following SAH. Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome.
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