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Cited by 398Dysphagia Assessment and ManagementStroke Rehabilitation and RecoveryVoice and Speech Disorders

Dysphagia in acute stroke: incidence, burden and impact on clinical outcome

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Arnold, Marcel, Liesirova, Kai, Broeg-Morvay, Anne, Meisterernst, Julia, Schlager, Markus, Mono, Marie-Luise, El-Koussy, Marwan, Kägi, Georg +2 more·2016·PLOS ONE
DOI 10.1371/journal.pone.0148424PMC PMC4749248
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Abstract

BACKGROUND: Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. METHODS: We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. RESULTS: Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, p<0.001), stayed longer at monitored stroke unit beds (4.4±2.8 vs. 2.7±2.4 days; p<0.001) and were less often discharged to home (19.5% vs. 63.7%, p = 0.001) as compared to those without dysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; p<0.001), less often lived at home (38.8% vs. 76.5%; p<0.001), and more often had died (13.6% vs. 1.6%; p<0.001). Multivariate analyses identified dysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. CONCLUSION: Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization.

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  • Early screening and structured dysphagia management improve outcomes in acute stroke.

    “Early screening and structured dysphagia management improve outcomes (Arnold et al., 2016; Martino et al., 2005), and enteral feeding strategies may be needed when aspiration risk is high (Duncan et al., 2020; Geeganage et al., 2012).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Arnold et al., 2016

    The Discussion (page unavailable) says regular dysphagia screening by trained therapists has been shown to decrease pneumonia in acute stroke patients, supporting an improvement in one outcome. It does not establish that early screening and structured dysphagia management broadly improve clinical outcomes; the study assessed associations between dysphagia and outcomes and calls for further research on management. (LLM, conf=0.83)

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Authors
Arnold, M., Liesirova, K., Broeg-Morvay, A., Meisterernst, J., Schlager, M., Mono, M.-L., El-Koussy, M., Kägi, G., Jung, S., & Sarikaya, H.
Affiliations
  • University Hospital of Bern (CH)
  • Kantonsspital St. Gallen (CH)
Corresponding author
Arnold, Marcel
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2016-02-10
Volume
11
Issue
2
Pages
e0148424
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0148424
PMC
PMC4749248
OpenAlex
W2262898288
Cited by
398
References
55
Citations by year
2026: 37 · 2025: 39 · 2024: 52 · 2023: 41 · 2022: 55 · 2021: 51 · 2020: 30 · 2019: 37 · 2018: 32 · 2017: 19 · 2016: 5
FWCI
64.52
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open Access CRIS of the University of Bern
Funders
Nestec
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Medicine › Physiology › Voice and Speech Disorders
Keywords
dysphagia, acute ischemic stroke, stroke severity, pneumonia, length of hospital stay, discharge disposition, institutionalization, mortality, nasogastric tube, Gugging Swallowing Screen, clinical outcomes
MeSH terms
Adult, Aged, Aged, 80 and over, Brain Ischemia, Deglutition, Deglutition Disorders, Enteral Nutrition, Female, Humans, Intubation, Gastrointestinal, Length of Stay, Male, Middle Aged, Patient Discharge, Pneumonia, Aspiration, Prospective Studies, Comorbidity, Thrombolytic Therapy, Incidence, Treatment Outcome, Stroke, Young Adult

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