on November 3, 2005
Published online before print November 3, 2005, doi: 10.1161/01.STR.0000190056.76543.eb
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on July 19, 2005
From the Graduate Department of Speech Language Pathology (R.M.), University of Toronto, Ontario, Canada; Toronto Western Research Institute (R.M., N.D.), University Health Network, Ontario, Canada; Department of Medicine (N.D.), University of Toronto, Ontario, Canada; Department of Physical Medicine and Rehabilitation (N.F., S.B., R.T.), St. Joseph’s Health Care London, Parkwood Hospital, Ontario, Canada; and Department of Epidemiology and Biostatistics (M.S.), University of Western Ontario, London, Ontario, Canada. * To whom correspondence should be addressed. E-mail: rosemary.martino{at}utoronto.ca.
Objective--To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. Methods--Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics. Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. Results--Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). Conclusions--The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.
Accepted on September 2, 2005
Dysphagia After Stroke. Incidence, Diagnosis, and Pulmonary Complications
Rosemary Martino PhD*;
Key words: dysphagia • epidemiology • outcomes • risk factors
This article has been cited by other articles:
 |
|
 |
|
  K. D. Heckert, E. Komaroff, U. Adler, and A. M. Barrett Postacute Reevaluation May Prevent Dysphagia-Associated Morbidity Stroke, April 1, 2009; 40(4): 1381 - 1385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Martino, F. Silver, R. Teasell, M. Bayley, G. Nicholson, D. L. Streiner, and N. E. Diamant The Toronto Bedside Swallowing Screening Test (TOR-BSST): Development and Validation of a Dysphagia Screening Tool for Patients With Stroke Stroke, February 1, 2009; 40(2): 555 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Warnecke, I. Teismann, S. Oelenberg, C. Hamacher, E. B. Ringelstein, W. R. Schabitz, and R. Dziewas The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients Stroke, February 1, 2009; 40(2): 482 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Harraf, K. Ward, W. Man, G. Rafferty, K. Mills, M. Polkey, J. Moxham, and L. Kalra Transcranial magnetic stimulation study of expiratory muscle weakness in acute ischemic stroke Neurology, December 9, 2008; 71(24): 2000 - 2007. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Foley, R. Teasell, K. Salter, E. Kruger, and R. Martino Dysphagia treatment post stroke: a systematic review of randomised controlled trials Age Ageing, May 1, 2008; 37(3): 258 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Warnecke, I Teismann, W Meimann, S Olenberg, J Zimmermann, C Kramer, E B Ringelstein, W R Schabitz, and R Dziewas Assessment of aspiration risk in acute ischaemic stroke--evaluation of the simple swallowing provocation test J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 312 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Matsuo, K. M. Hiiemae, M. Gonzalez-Fernandez, and J. B. Palmer Respiration during feeding on solid food: alterations in breathing during mastication, pharyngeal bolus aggregation, and swallowing J Appl Physiol, March 1, 2008; 104(3): 674 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Trapl, P. Enderle, M. Nowotny, Y. Teuschl, K. Matz, A. Dachenhausen, and M. Brainin Dysphagia Bedside Screening for Acute-Stroke Patients: The Gugging Swallowing Screen Stroke, November 1, 2007; 38(11): 2948 - 2952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Sellars, L. Bowie, J. Bagg, M. P. Sweeney, H. Miller, J. Tilston, P. Langhorne, and D. J. Stott Risk Factors for Chest Infection in Acute Stroke: A Prospective Cohort Study Stroke, August 1, 2007; 38(8): 2284 - 2291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Atkinson, H. Zhu, F. Qiao, J. C. Varela, J. Yu, H. Song, M. S. Kindy, and S. Tomlinson Complement-Dependent P-Selectin Expression and Injury following Ischemic Stroke J. Immunol., November 15, 2006; 177(10): 7266 - 7274. [Abstract] [Full Text] [PDF]
|
|