The Contribution of Dysphagia to Acute Stroke Morbidity and Mortality in Nigeria: A Prospective Study

Abstract

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without dysphagia) in terms of stroke characteristics and 30-day outcome.

Results: Of the recruited 200 patients, 99 (49.5%) had dysphagia. Patients with intracerebral haemorrhagic stroke had a significantly higher prevalence of dysphagia (64% vs 36%; p<0.001). At baseline, dysphagic patients had more severe (Mean NHISS score, 22.81 Vs 8.92; p=0.01) and subcortical strokes (57.1% vs 42.9%, p = 0.015). At 30 days after stroke, the mean MRS was significantly higher in the dysphagic stroke patients (3.8±1.02) compared to those without dysphagia (2.5±1.3), (p = 0.001)]. Case fatality was higher among the dysphagic (79.8% vs 15.84%; p = 0.001) and the mean survival time was lower (12.21 days) among the dysphagic group (p = 0.001)

Conclusion: Severe stroke, subcortical stroke and haemorrhagic stroke types were significantly associated with dysphagia at baseline. Dysphagia adversely influenced 30-days morbidity and case fatality in this cohort of acute stroke patients.