Henke Christian, Foerch Christian, Lapa Sriramya
Department of Neurology, HELIOS HSK Wiesbaden, Wiesbaden, Germany.
Cerebrovasc Dis. 2017;44(5-6):285-290. doi: 10.1159/000480123. Epub 2017 Sep 14.
Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke.
Our analysis was based on data from a prospective in-hospital registry. Patients with ischemic stroke were included over the course of 3 years. Patients were scheduled to undergo a clinical swallowing investigation within the first 24 h after hospital admission. Step-wise multivariate logistic regression was used to identify independent predictors of dysphagia in general and of pneumonia in particular.
1,646 patients with ischemic stroke were included. Stroke severity in terms of higher National Institute of Health Stroke Scale (NIHSS) values (p < 0.001), male gender (p = 0.006) and higher age (p < 0.001) independently predicted dysphagia. A receiver operating characteristics analysis revealed an NIHSS cut-off value of 4.5 for optimal differentiation between patients with and without dysphagia (sensitivity 0.77; specificity 0.77). Dysphagia (p < 0.001), male gender (p = 0.002), higher NIHSS scores (p < 0.001) and higher age (p = 0.002) were factors that were independently associated with pneumonia. The NIHSS cut-off value for differentiating between patients with and without pneumonia was 5.5 (sensitivity 0.91; specificity 0.67).
Stroke severity in terms of NIHSS is a simple and reliable predictor of dysphagia. Patients with NIHSS values ≥5 should be quickly directed towards a professional swallowing examination. Dysphagia was confirmed to be a strong predictor of pneumonia.
吞咽困难是急性脑卒中患者的常见症状。它与营养不良、误吸及死亡率相关。因此，识别能迅速引导进行专业吞咽检查的吞咽困难早期筛查参数至关重要。本研究旨在检测一大群急性缺血性脑卒中患者中吞咽困难的早期且易于评估的预测因素。
我们的分析基于前瞻性院内登记数据。在3年期间纳入缺血性脑卒中患者。患者入院后24小时内计划进行临床吞咽调查。采用逐步多因素逻辑回归来确定吞咽困难及尤其是肺炎的独立预测因素。
纳入1646例缺血性脑卒中患者。较高的美国国立卫生研究院卒中量表（NIHSS）值所反映的卒中严重程度（p<0.001）、男性（p = 0.006）及较高年龄（p<0.001）独立预测吞咽困难。受试者工作特征分析显示，NIHSS临界值为4.5时，对有或无吞咽困难患者的区分最佳（敏感性0.77；特异性0.77）。吞咽困难（p<0.001）、男性（p = 0.002）、较高的NIHSS评分（p<0.001）及较高年龄（p = 0.002）是与肺炎独立相关的因素。区分有或无肺炎患者的NIHSS临界值为5.5（敏感性0.91；特异性0.67）。
NIHSS所反映的卒中严重程度是吞咽困难的简单可靠预测因素。NIHSS值≥5的患者应迅速接受专业吞咽检查。吞咽困难被证实是肺炎的有力预测因素。
