Study of predictors of dysphagia in acute stroke

Abstract

Stroke is a complex neurological disease caused by multiple factors. Currently, stroke is a major public health problem, being the second most frequent cause of death in the world. In Brazil, stroke is the leading cause of death and physical and functional disability in adulthood. This study will focus on the sequelae of swallowing and its implications over multiples aspects of subjects' lives, such as compromised nutritional status, eating pleasure, and pulmonary conditions. The aspiration pneumonia constitutes a major factor, being responsible for increased hospitalization time and cost of medical and hospital care, as well as high mortality rate of patients after stroke. One way to evaluate swallowing is through screening, an important tool in early detection of dysphagia in stroke. The aim of the research is to identify the clinical predictors for the presence of oropharyngeal dysphagia in patients with acute stroke. This is a cross sectional study and a quantitative approach, approved by Ethics Research Committee under number 1038/2011. Patients included in the study must present the following characteristics: (a) both gender; (b) greater than 18 years; (c) having first stroke in any brain topography; (d) submitted to neuroimaging exam; (e) submitted to swallowing evaluation by screening tool in acute stroke (within 72 hours after onset symptoms); and (f) agreed to participate in research by signing the consent form. Will be considered 100 consecutive patients admitted by Emergency Unit, neurological ward and neurological intensive care unit of Clinical Hospital of University of Campinas. Will be excluded from the study patients presenting tracheal intubation, coma, lowered level of consciousness or having other diseases that may interfere in swallowing. Data will be gathered from: (a) patients´ records to sociodemography and clinical characterization; (b) application of The National Institutes of Health Stroke Scale and modified Rankin Scale; (c) application of the swallowing screening tool, involving questions about the cognitive-linguistic condition, sensorimotor oral condition, and functional swallowing condition; (d) application of Functional Oral Intake Scale; (e) Fiberoptic endoscopic evaluation of swallowing; (f) analysis of neuroimaging exams to classify the site and extent of brain injury; (g) application of Alberta Stroke Program Early CT Scale; (h) application of The Boston Acute Stroke Imaging Scale; and (i) Oxfordshire Classification.