English abstract
Background: Dysphagia following a stroke occurs frequently in stroke populations. Up
to 80% of stroke patients suffer from dysphagia. It is associated with increased
morbidity, mortality and healthcare costs due to aspiration, pneumonia, and malnutrition,
which represent a significant burden to stroke survivors, their relatives and the healthcare
system. Early recognition and management of poststroke dysphagia is key to reducing its
complications and enhancing patients' quality of life. Despite the importance of
dysphagia following a stroke and its adverse consequences, no study has investigated
dysphagia after stroke in Oman.
Aim: The study was conducted to estimate the prevalence of poststroke dysphagia and its
severity among acute stroke patients, assess the association between the selected factors
and dysphagia, identify dysphagia predictors and explore its impacts on clinical
outcomes (degree of disability including mortality, presence of nasogastric tube (NGT)
and stroke-associated pneumonia and length of hospitalization).
Method: A cross-sectional descriptive study design was utilized to identify the
prevalence and risk factors for poststroke dysphagia and its clinical outcomes among
acute stroke patients (n=274) admitted to two Omani tertiary hospitals (Sultan Qaboos
University Hospital and Khoula Hospital) over six months. Dysphagia was assessed
using the Gugging swallowing screen (GUSS). The Modified Rankin Scale (mRS) was
used to measure the degree of disability, including mortality at discharge. Descriptive
analysis, correlations and regression analysis were computed.
Results: The prevalence of dysphagia following stroke was 70.1%. Among those who
had dysphagia, 37.5% had severe, 31.25% moderate, and 31.25% mild dysphagia. Aging,
obesity, having a medical comorbidity, hypertension (HTN), stroke location, low
Glasgow Coma Scale (GCS) score, and the use of thrombectomy or thrombolysis therapy
were contributing factors and were found to be correlated with poststroke dysphagia.
This study revealed that old age (OR =.961, 95% CI:.933 -.989, p = 0.007), obesity (OR
=.387, 95% CI:.157 -.952, p =.039), and low GCS score (OR =.027, 95% CI:.009 –.077,
p= <.001) were predictors of dysphagia after stroke. It is also significantly associated
with prolonged NGT use during admission and at discharge and length of hospital stay
and an increased degree of disability, including mortality and incidence of stroke associated pneumonia.
Conclusion: Poststroke dysphagia is more common among acute stroke patients, and it is
associated with negative outcomes. There are various risk factors correlated with
dysphagia following a stroke. Therefore, dysphagia predictors should be considered
when designing dysphagia prevention strategies to reduce its adverse consequences.
Recognition of such predictors may help with the early detection and treatment of
dysphagic patients and the implementation of preventive approaches.
