Changes in swallowing after cerebrovascular accidents: incidence, natural history and repercussions on nutritional status, morbidity and mortality
Objective. To determine the frequency of dysphagia in CVA, its natural history and value as a risk factor of respiratory infection, malnutrition and death. Patients and methods. A prospective study was made of 187 consecutive patients with cerebrovascular accidents (CVA). A standardized test for dysphagia was done during the first two days of the illness and repeated three days a week. The levels of urea, total proteins and albumin were determined on admission and on discharge. The patients were questioned by phone after 6 months. Results. There was dysphagia of liquids in 36.4% of the patients. The incidence of dysphagia for semisolids was of the same frequency but more severe. Coma was the cause of inability to swallow in 25.7% of the patients. During their stay in hospital one third of the patients with dysphagia died, one third became normal and one third still had dysphagia when they were discharged. After one week, one, three and six months respectively, the cure rate for dysphagia was 29.4%, 4.1%, 55.9% and 55.9%, and survival 83.8%, 67.6%, 61.8% and 60.3%. Thus after 6 months only 3 patients (4.4%) were alive and dysphagic. Half of the ‘cures’ occurred in the first week, and none occurred after more than 77 days. As compared to the non-dysphagic patients, the dysphagic patients had 10 times more risk of respiratory infection, 18 times higher risk of death, greater loss of albumin and less loss of urea. Conclusions. There is a high prevalence of dysphagia in CVA and although functional prognosis is not unfavorable, respiratory infections, malnutrition and death are frequent
Pacientes y métodos Estudio prospectivo de 187 pacientes consecutivos con AVC. Test estandarizado de disfagia en los primeros dos días de evolución, repetido tres días semanales. Determinación de urea, proteínas totales y albúmina al ingreso y al alta. Encuesta telefónica a los 6 meses.
Resultados Hubo disfagia a líquidos en el 36,4% de los casos y a semisólidos con igual frecuencia pero mayor intensidad. Un 25,7% de los casos de deglución imposible se debieron a coma. Durante el ingreso, un tercio de los pacientes con disfagia falleció, en un tercio se resolvió y otro tercio fue dado de alta con disfagia. A la semana, 1, 3 y 6 meses la tasa de curaciones de la disfagia fue del 29,4, 41,1, 55,9 y 55,9%, y la de supervivencia del 83,8, 67,6, 61,8 y 60,3%, respectivamente, de modo que a los 6 meses sólo 3 pacientes (4,4%) seguían vivos y disfágicos. La mitad de las curaciones se dieron en la primera semana, y no hubo ninguna transcurridos 77 días. Los disfágicos tuvieron respecto a los no disfágicos 10 veces más riesgo de infección respiratoria, 18 veces más riesgo de muerte, mayores pérdidas de albúmina y menores pérdidas de urea.
Conclusiones La disfagia tiene una elevada prevalencia en los AVC, y, aunque su pronóstico funcional no es malo, se acompaña de una alta frecuencia de infecciones respiratorias, desnutrición y muerte
