Introduction: Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia. In the acute phase of stroke, the frequency of dysphagia is greater than 50%. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient.
Hypothesis: The aim of this study was to identify predictive clinical factors associated with enteral tube feeding in acute ischemic stroke patients.
Methods: The medical records of 326 acute ischemic stroke patients from our prospective stroke database were reviewed. Clinical factors as age, sex, comorbidities, blood pressure, glycemia, National Institutes of Health Stroke Scale (NIHSS) score and subscores, Glasgow Come Scale (GCS), previous Rankin, Alberta Stroke Program Early CT score (ASPECTS) and localization of acute stroke were analyzed. Logistic regression was used to develop a risk score by weighting predictors of enteral tube feeding placement based on strength of association.
Results: Of the 326 patients, 84 used enteral feeding tubes (25.8%). The mean age (70.2 years - SD 13.1), mean GCS (12.7 - SD 2.1), mean NIHSS (12.6 - SD 5.6), and Aspect score (8.8 - SD 1.8) were significantly higher in the tube group. Logistic regression showed that only age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.6. P=0,025), NIHSS score (OR, 1.15; 95% CI, 1.05-1.25, P= 0,001) and NIHSS 10 (dysarthria) subscore (OR, 2.2; 95% CI, 1.2-4.05, P=0,011) were independent predictors of enteral tube feeding. A 3-item risk score was developed based on the regression model in order to identify those patients needing enteral feeding. A score ≥ 4 predicted tube feeding in 75% of cases.
Conclusions: In conclusion, combining information about age, NIHSS, NIHSS 10 subscore, may be a useful predictor tool for clinical decision for enteral tube feeding in acute ischemic stroke patients.