Aspiration and Relative Risk of Medical Complications Following Stroke

Abstract

Objective: To determine the relative risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration, silent aspiration, aspiration of 10% or greater on one or more barium test swallows, and aspiration of thick liquid or more solid consistencies in the subacute phase after stroke. Design: Prospective, longitudinal cohort study. Setting: Inpatient stroke rehabilitation unit. Patients: There were 114 consecutive patients who met the following criteria: (1) stroke as defined by clinical history and neurological examination with compatible computed tomographic or magnetic resonance imaging scan; (2) age 20 to 90 years, inclusive; (3) no known history of significant oropharyngeal anomaly; and (4) videofluoroscopic evidence of dysphagia. Of 122 eligible patients, eight refused participation. Main Outcome Measures: Development of pneumonia, dehydration, and death. Results: The relative risk for developing pneumonia was 6.95 times greater (P=.027) for those patients who aspirated comparedwith those who did not, 5.57 times greater (P=.012) for those who aspirated silently compared with those who coughed when aspirating or who did not aspirate, and 8.36 times greater (P=.002) for those who aspirated 10% or greater on one or more barium test swallows compared with those who aspirated less than 10% or did not aspirate. Conclusion: Aspiration, silent aspiration, and aspiration of 10% or greater on one or more barium test swallows during videofluoroscopic evaluation are associated with an increased risk of pneumonia, but not dehydration or death, during the subacute phase after stroke.