Risk factor assessment and phased management for post-stroke dysphagia in hospitalized patients: a retrospective evidence-based study.

BACKGROUND

Post-stroke dysphagia (PSD) is a common functional impairment after stroke and is associated with aspiration, pneumonia, malnutrition, and reduced rehabilitation safety. Existing studies have mainly examined PSD risk factors at a single stage of recovery, with limited evidence on phase-specific risk assessment in inpatient rehabilitation settings. This study aimed to investigate the prevalence of PSD and its associated risk factors across different phases of the disease course in hospitalized stroke patients and to inform phase-based management strategies.

METHODS

A retrospective observational study was conducted among 5,363 stroke patients admitted to the Department of Rehabilitation Medicine at Xiangyang Central Hospital, Hubei, China, between January 2021 and December 2023. PSD was screened using the Chinese version of the Eating Assessment Tool-10 (EAT-10). The disease course was classified as acute (within 2 weeks post-stroke), subacute (2 weeks to 6 months), and chronic phases (beyond 6 months). Group differences were examined using the chi-square test, and multi-variate logistic regression was performed to identify factors independently associated with PSD overall and within each phase.

RESULTS

Among the 5,363 patients, 2,306 had PSD, yielding an overall prevalence of 43.0%. In the overall analysis, intracerebral hemorrhage (ICH, OR 1.79, 95% CI 1.54-2.09), subarachnoid hemorrhage (SAH, OR 2.22, 95% CI 1.58-3.14), brainstem lesion (OR 1.79, 95% CI 1.43-2.24), cerebellar lesion (OR 1.71, 95% CI 1.28-2.31), advanced age (OR 2.08, 95% CI 1.82-2.38), and previous surgery of stroke (OR 1.32, 95% CI 1.17-1.51) were independently associated with higher PSD risk. Subcortical lesion (OR 0.72, 95% CI 0.62-0.85) and higher education status (OR 0.55, 95% CI 0.43-0.70) were protective factors. Phase-specific analyses showed that SAH and cortical lesion were the main risk factors in the acute phase, ICH and brainstem lesion in the subacute phase, and advanced age and ICH in the chronic phase.

CONCLUSION

PSD is common among hospitalized stroke patients undergoing rehabilitation, and its risk profile varies across disease phases. Phase-based screening and management strategies may improve early identification, guide individualized rehabilitation, and reduce dysphagia-related complications.