Swallowing function after XXXX : prognosis and prognostic factors at 6 months.

@entity1 @entity64 @entity66 @entity409 @entity5837 @entity1282 @entity204 @entity1173
BACKGROUND AND PURPOSE: @entity409 ( @entity1282 ) is common and disabling after @entity64 , but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after @entity64 and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications. METHODS: We prospectively assembled an inception cohort of 128 hospital-referred @entity1 with acute first @entity64 . We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of @entity64 onset, using standardized methods and diagnostic criteria. All @entity1 were followed up prospectively for 6 months for the occurrence of @entity204 , recurrent @entity64 , @entity5837 , recovery of swallowing function, and return to normal diet. RESULTS: At presentation, a swallowing abnormality was detected clinically in 65 @entity1 (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 @entity1 (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 @entity1 (20%; 95% CI, 14% to 28%) suffered a @entity5837 . At 6 months after @entity64 , 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 @entity1 (50%; 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 @entity1 who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 @entity1 and @entity1173 in another 17. The single independent baseline predictor of @entity5837 during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, @entity5837 , or @entity1173 at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the laryngeal vestibule, age >70 years, and male sex. CONCLUSIONS: Swallowing function should be assessed in all @entity64 @entity1 because swallowing dysfunction is common, it persists in many @entity1 , and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing @entity66 are videofluoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies.
