Clinical characteristics of dysphagic stroke patients with salivary aspiration: A STROBE-compliant retrospective study

Abstract

The aim of this study was to evaluate the correlation between radionuclide salivagram findings and clinical characteristics in stroke patient with swallowing difficulty.In this study, dysphagic stroke patients who had undergone both a radionuclide salivagram and videofluoroscopic swallowing study (VFSS) were included retrospectively. To evaluate the correlations between clinical parameters and salivary aspiration, clinical parameters, such as stroke lesion, the degree of paralysis, sex, age, onset duration of stroke, the score of the Mini-Mental State Examination (MMSE), the score of the Global Deterioration Scale (GDS), the total score of the Modified Barthel Index (MBI), and each sub-score of the MBI were collected and analyzed.In the results of this study, the MMSE score was the only significant parameter for predicting positive findings in a salivagram in a multivariate logistic regression analysis in patients with supratentorial stroke. In patients with infratentorial stroke, however, the transfer sub-score of MBI was the only significant parameter for predicting positive findings in a salivagram in a multivariate logistic regression analysis.In conclusion, care should be taken to prevent salivary aspiration when the MMSE score is less than eight in patients with supratentorial stroke, and the transfer sub-score of MBI score is less than three in patients with infratentorial stroke.

Figure 1

Flow chart of inclusion and exclusion criteria of the study sample. HIE = hypoxic ischemic encephalopathy, IPD = idiopathic Parkinson's disease, MBI = Modified Barthel Index, MMSE = Mini-Mental State Examination, TBI = traumatic brain injury, VFSS = videofluoroscopic swallowing study.

Figure 2

(A) ROC curve of MMSE score for developing salivary aspiration in supratentorial stroke patients with dysphagia. The optimal cut-off value (dots on the curves) for MMSE score, which was obtained from the maximal Youden's index, was a score of 8 or less for development of aspiration pneumonia (AUC, 0.784; 95% confidential interval, 0.664–0.925; P < .05; sensitivity: 90.91%, specificity: 79.52%). (B) ROC curve of transfer sub-score of Modified Barthel Index (MBI) for developing salivary aspiration in infratentorial stroke patients with dysphagia. The optimal cut-off value (dots on the curves) for total MBI score, which was obtained from the maximal Youden's index, was a score of 3 or less for development of aspiration pneumonia (AUC, 0.517; 95% confidential interval, 0.332–0.804; P < 0.05; sensitivity: 90.91%, specificity: 88.89%). AUC = area under the ROC curve, MMSE = Mini-Mental State Examination, ROC = receiver operating characteristic.