Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 9; pp. 2088 - 2094
• Main Authors: Ribeiro, Priscila W., MSc, Cola, Paula C., PhD, Gatto, Ana R., MSc, da Silva, Roberta G., PhD, Luvizutto, Gustavo J., MSc, Braga, Gabriel P., MD, Schelp, Arthur O., PhD, de Arruda Henry, Maria A.C., PhD, Bazan, Rodrigo, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2015
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - complications; Cardiovascular; deglutition; deglutition disorders; Deglutition Disorders - etiology; Deglutition Disorders - rehabilitation; dysphagia; Female; Humans; Logistic Models; Male; Middle Aged; National Institutes of Health (U.S.) - standards; Neurologic Examination; neurologic impairment; Neurology; Pneumonia - diagnosis; Pneumonia - epidemiology; Pneumonia - etiology; pneumonia predictors; Predictive Value of Tests; Severity of Illness Index; Speech Therapy; Statistics, Nonparametric; Stroke; Stroke - complications; Stroke - epidemiology; Stroke - etiology; United States; United States; deglutition; dysphagia; neurologic impairment; Stroke; pneumonia predictors; deglutition disorders
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.009

Background The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. Methods This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann–Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. Results The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age ( P  = .002; odds ratio [OR], 1.12) and NIHSS score ( P  = .04; OR, 1.17), whereas laryngeal penetration of liquid ( P  = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. Conclusions There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.