Department of Family and Emergency Medicine, University of Fukui Hospital, Fukui, Japan.
TXP Medical Co. Ltd., Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105804. doi: 10.1016/j.jstrokecerebrovasdis.2021.105804. Epub 2021 Apr 24.
Prolonged dysphagia is an important stroke-related complication that imposes a substantial burden on patients and families. However, simple scoring tool to predict prolonged dysphagia is not existing.
This retrospective cohort study used data from April 2010 to March 2016. Adult patients with first-ever stroke were included. The outcome was swallowing function at discharge from the subacute care hospital to the patient's home. We collected the following factors obtained at discharge from the University of Fukui Hospital: age, sex, type of stroke, comorbidities, smoking status, alcohol use, denture use, functional dependency in daily living before admission, National Institutes of Health Stroke Scale score (NIHSS) at admission, and Functional Independence Measure(FIM). Data were divided into a training set (70%) and test set (30%). Lasso and logistic regression were used for feature selection, a scoring system was then developed, and its prediction performance evaluated.
This study enrolled 462 patients with acute stroke. Using lasso and logistic regression, three variables (functional dependency before admission, Functional Independence Measure [FIM]-cognitive and FIM-motor scores at transfer) remained statistically significant predictors of prolonged dysphagia. Risk scores were categorized as low risk (0-2), moderate risk (3-4), and high risk (5-7), with dysphagia rates of 0%-1%, 13%-29%, and 50%-100%, respectively. A newly developed score ≥3 was the optimal cutoff for identifying patients with the potential risk of prolonged dysphagia (C-statistics, 0.92 in the test set).
The developed scoring system is simple and has a high performance in predicting prolonged dysphagia after acute stroke.
吞咽困难时间延长是一种重要的与中风相关的并发症，给患者和家庭带来了很大的负担。然而，目前还没有简单的评分工具来预测吞咽困难时间延长。
本回顾性队列研究使用了 2010 年 4 月至 2016 年 3 月的数据。纳入首次中风的成年患者。结局为从亚急性护理医院出院后患者的吞咽功能。我们收集了从福井大学医院出院时获得的以下因素：年龄、性别、中风类型、合并症、吸烟状况、饮酒状况、是否使用义齿、入院前日常生活功能依赖程度、入院时国立卫生研究院中风量表评分（NIHSS）和功能独立性测量（FIM）。数据分为训练集（70%）和测试集（30%）。使用套索和逻辑回归进行特征选择，然后开发评分系统，并评估其预测性能。
本研究纳入了 462 例急性中风患者。使用套索和逻辑回归，三个变量（入院前日常生活功能依赖程度、转移时 FIM-认知和 FIM-运动评分）仍然是吞咽困难时间延长的统计学显著预测因素。风险评分分为低危（0-2 分）、中危（3-4 分）和高危（5-7 分），吞咽困难发生率分别为 0%-1%、13%-29%和 50%-100%。新开发的评分≥3 是识别有延长性吞咽困难潜在风险患者的最佳截断值（测试集中的 C 统计量为 0.92）。
所开发的评分系统简单，在预测急性中风后吞咽困难时间延长方面具有较高的性能。
