Longitudinal outcomes of severe post-stroke dysphagia: high mortality, partial recovery, and persistent dependence on alternative feeding.

OBJECTIVE

This study evaluated the progression of swallowing function and clinical outcomes in patients with severe dysphagia following Ischemic Stroke (IS), monitoring them from hospital admission to three months post-discharge. The primary aim was to evaluate swallowing recovery, clinical outcomes, and mortality risk in severe post-IS dysphagia over three months.

METHODS

Retrospective cohort study of 48 IS patients admitted to the Emergency Room (ER) of a tertiary hospital with persistent dysphagia (Functional Oral Intake Scale [FOIS] 1-4 at three weeks). Data included FOIS/EAT-10 scores, feeding methods, complications, and survival. Outcomes were analyzed at admission, three weeks, and three months.

RESULTS

Mortality: 50% died by 3-months, associated with older age, high NIHSS scores (median 16), and pre-existing neurological deficits (p < 0.05). 62.5% of survivors resumed oral intake (FOIS ≥ 5), but 75% reported persistent dysphagia (EAT-10 ≥ 3). 25% developed pneumonia; 33% received gastrostomy despite guidelines. Vertebrobasilar strokes showed lower mortality (p = 0.019).

CONCLUSION

Severe post-IS dysphagia carries high mortality and prolonged functional impairment. While partial recovery occurs, dependence on alternative feeding and complications persist, underscoring the need for multidisciplinary follow-up.