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The predictive dysphagia score (PreDyScore) in the short- and medium-term post-stroke: a putative tool in PEG indication

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Abstract

Purpose

We performed an evaluation of dysphagia in an unselected series of strokes to identify factors causing persisting dysphagia at 1 month after onset and to formulate a predictive score.

Methods

We evaluated the association between dysphagia and clinical aspects (univariate analysis) at the 7th and 30th days after admission. We performed a multivariate logistic regression at the 30th day on the factors that were significant. We computed a simple score for predicting persistent dysphagia.

Results

We recruited 249 patients. At the 7th day, 94 patients were dysphagic (37.75%). Factors associated with dysphagia included TACI (OR 3.85), mRS ≥ 3 (OR 4.45), malnutrition (OR 2.69), and BMI ≥ 20 (OR 0.52). At the 30th day, 217 patients remained in the study, and dysphagia persisted in 75 (36.76%). The factors that were associated with dysphagia were age > 74 years (OR 1.99), TACI (OR 5.82), mRS score ≥ 3 (OR 4.31), malnutrition (OR 3.27), and BMI ≥ 20 (OR 0.45). The multivariate analysis indicated that mRS ≥ 3 (OR 1.80) and BMI ≥ 20 (OR 0.45) remained significantly associated with dysphagia. The best correlation with dysphagia was the sum of mRS and the reciprocal of the BMI multiplied by 100 ((mRS + 1 ∕ BMI) × 100). We named this score PreDyScore that ranged between 3.7 and 10.47. Using < 6 and > 8 as cutoffs, the sensitivity was 67.03%, and the specificity 95.65%.

Conclusion

BMI < 20 and mRS ≥ 3 are easily measurable bedside predictive factors of persistent dysphagia. PreDyScore showed good sensitivity and very good specificity and enables the prediction of persistent dysphagia with great accuracy in any clinical setting.

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Acknowledgments

PreDyScore Group:

• Maria Gabriella Ceravolo MD (***), m.g.ceravolo@univpm.it

• Fiorenzo Cortinovis MD (§), fcortinovis@asst-pg23.it

• Cinzia Finocchi MD (*), cfinocchi@neurologia.unige.it

• Raffaella Gradaschi RD (**), raffaella.gradaschi@hsanmartino.it

• Paolo Orlandoni MD (§§), p.orlandoni@inrca.it

• Nicoletta Reale (*) PhD, alice@neurologia.unige.it

• Stefano Ricci MD(^), stefano.ricci@uslumbria1.it

• Daniela Vassallo MD (^^), daniela.vassallo@unito.it

• Andrea Zini MD (°), a.zini@ausl.bologna.it

Affiliations and addresses of the authors:

(*) Clinica Neurologica dell’Università di Genova, Italy, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e la Neurologia, Genoa, Italy

(**) Unità Operativa Dietetica e Nutrizione Clinica, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e la Neurologia, Genoa, Italy

(***) Clinica della Riabilitazione, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Italy

(§) Malattie Endocrine 2, Dietetica, nutrizione clinica e disturbi alimentari, ASST Papa Giovanni XXIII, Bergamo, Italy

(§§) Unità Operativa Nutrizione Clinica IRCCS INRCA, Ancona, Italy

(^) Unità Operativa Neurologia, USL Umbria 1, Città di Castello, Perugia, Italy

(^^) Unità Operativa Dietologia e Nutrizione Clinica, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy

(°) UOC Neurologia IRCCS Istituto di Scienze Neurologiche di Bologna AUSL, Bologna, Italy

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Authors and Affiliations

  1. Clinica Neurologica dell’Università di Genova, Genoa, Italy

    Carlo Gandolfo

  2. IRCCS per l’Oncologia e la Neurologia, Ospedale Policlinico San Martino, Genoa, Italy

    Carlo Gandolfo

  3. Unità Operativa Dietetica e Nutrizione Clinica, IRCCS per l’Oncologia e la Neurologia, Ospedale Policlinico San Martino, Genoa, Italy

    Samir Sukkar

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  1. Carlo Gandolfo
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  2. Samir Sukkar
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  3. Maria Gabriella Ceravolo
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on the behalf of the PreDyScore Group

Corresponding author

Correspondence to Carlo Gandolfo.

Ethics declarations

The study has been approved by the ethics committee of the Policlinico San Martino of Genoa and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Details that might disclose the identity of the subjects under study have been omitted before the analysis. All recruited persons gave their informed consent prior to their inclusion in the study.

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The authors declare that they have no conflicts of interest.

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Gandolfo, C., Sukkar, S., on the behalf of the PreDyScore Group. et al. The predictive dysphagia score (PreDyScore) in the short- and medium-term post-stroke: a putative tool in PEG indication. Neurol Sci 40, 1619–1626 (2019). https://doi.org/10.1007/s10072-019-03896-2

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  • DOI: https://doi.org/10.1007/s10072-019-03896-2

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