Early complications related to swallowing disorders after ischemic stroke: predictive factors?

Résumé 0

Background In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are reported to be frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in patients with acute ischemic stroke during the 7 first days of their hospitalisation and their risk of BP, and to try to identify early predictors for these conditions. Methodology A retrospective study evaluating patients suffering from acute ischemic stroke, admitted to the Stroke Unit of Lausanne (Switzerland) during one year or the year 2015. In this unit, each patient undergoes a standardised protocol for early detection of SD. The following factors have been analysed: demographic characteristics, stroke features, dental status, presence of a feeding tube, SD and BP, and mortality rate. Results Out of 343 patients (157 women, mean age 72±14), SD were identified early in 81 patients (23.6%); 24 (29.6%) patients with SD and 15 (5.7%) without SD developed BP. SD were more frequently seen in patients suffering from an anterior stroke, or a more severe stroke, or with cardio-embolic stroke. When we compared patients with and without SD, the SD group more frequently had a dental prosthesis (16.1% vs 3.8%) or a feeding tube (55.6% vs 4.2%). SD associated with BP were more frequently seen in patients with a posterior stroke or with simultaneous anterior and posterior strokes. They had a higher NIHSS score (14.6±8.5 SD), more dental prostheses (4, 16.7%) and more feeding tubes (18, 75.0%). The multivariate analysis demonstrates that the association of a NIHSS score above 4, bulbar stroke and wearing a dental prosthesis can predict 76% of patients with SD. The association of a NIHSS score greater than 4, male sex, bilateral hemispheric lesions, an enteral feeding tube and SD can predict 84% of the risk of BP. Conclusion We have identified some independent predictive factors that can significantly increase the risk of SD and of BP after an ischemic stroke. Their early identification could predict these complications, and lead to prevent them by earlier management by a speech therapist and monitoring of respiratory function.