Evaluation of swallowing in acute ischemic stroke patients using both a simple swallowing provocation test and a water swallowing test

Abstract

Aspiration pneumonia is a common complication among acute stroke patients and is an important factor affecting their mortality and morbidity. Thus, it is imperative to evaluate their swallowing as early as possible to prevent aspiration pneumonia. In this study, we performed both a simple swallowing provocation test (SSPT) and a water swallowing test (WST) for patients with acute ischemic stroke, and evaluated whether these tests and the combined screening method using both tests were useful. For this purpose, we performed both tests continuously on the first or second hospital day before the start of diet in 127 patients who were suspected to have dysphagia. We performed statistical analyses to determine whether there was an association between aspiration pneumonia, these tests, and the combined screening method.
Eighteen patients (14.2%) developed aspiration pneumonia in the hospital. Significant risk factors for pneumonia were aging, male gender, and the severity of stroke on admission. SSPT was successfully performed in all patients, whereas WST failed to be completed in 14 patients (11.0%), 8 of whom developed pneumonia. An abnormal response to either SSPT or WST was significantly associated with pneumonia. In addition, multiple logistic regression analysis showed that an abnormal response to our combined screening method was an independent risk factor for pneumonia (p=0.012, odds ratio 9.79, 95% confidence interval 1.64–8.43).
Our combined screening method using both SSPT and WST is useful for the evaluation of swallowing in acute ischemic stroke patients, because it can be used for all patients with various underlying conditions.