Recovery of Swallowing after Dysphagic Stroke: An Analysis of Prognostic Factors Sandeep Kumar, MD,* Christopher Doughty, BA,† Gheorghe Doros, PhD,‡ Magdy Selim, MD, PhD,* Sourabh Lahoti, MBBS,* Sankalp Gokhale, MD,* and Gottfried Schlaug, MD, PhD* Background: Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify impor- tant prognostic variables affecting swallowing recovery after acute ischemic stroke. Methods: We retrospectively reviewed our patient database to identify acute ischemic stroke patients who developed dysphagia after stroke but were free of other confound- ing conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness (LOC), facial weakness, dysarthria, ne- glect, bihemispheric infarcts, right hemispheric infarcts, brainstem infarcts, intuba- tion, aspiration, acute stroke therapies, occurrence of symptomatic hemorrhagic transformation, seizures, pneumonia, and length of hospitalization (LOH) on persis- tence of dysphagia at hospital discharge in a logistic regression analysis. Results: The mean age and NIHSS scores (mean 6 standard deviation) were 75.9 6 13.6 years and 13.5 6 6.9, respectively; 58.5% were women. In a multivariate analysis, aspiration detected on a clinical swallowing evaluation (odds ratio [OR] 21.83; 95% confidence in- terval [CI] 8.16-58.42; P , .0001), aspiration on videofluoroscopic swallowing study (OR 10.50; 95% CI 3.35-32.96; P , .0001), bihemispheric infarcts (OR 3.72; 95% CI 1.33-10.43; P 5 .0123), dysarthria (OR 3.4; 95% CI 1.57-7.35; P 5 .0019), intubation (OR 2.86; 95% CI 1.10-7.39; P 5 .0301), NIHSS score $12 (OR 2.51; 95% CI 1.19-5.23; P 5.0157) were significant predictors of persistent dysphagia. The area under the curve and Somer’s D xy statistics of the model were 0.8918 and 0.78, respectively, indicating good calibration and discriminative power. Conclusions: Prognostic factors affecting swallowing recovery identified in this study can help advance dysphagia research methodologies and the clinical care of stroke patients. Key Words: Dysphagia—multivariate logistic regression analysis—prognosis—predictors. Ó 2014 by National Stroke Association Dysphagia is a serious complication of stroke and is closely linked with aspiration and pneumonia. 1 Bedside or instrumental swallowing assessments can readily de- tect swallowing impairments in stroke patients, but pre- dicting the prognosis for eventual swallowing recovery remains difficult. The early identification of patients with a poor potential for swallowing recovery can be very beneficial, especially during hospitalization, when decisions about alternative feeding methods, such as the placement of percutaneous endoscopic gastrostomy (PEG) tubes, timing of hospital discharge, and discharge destination must be made. An important step in miti- gating these gaps in knowledge is to identify the From the *Department of Neurology, Stroke and Cerebrovascular Division, Beth Israel Deaconess Medical Center; †Harvard Medical School; and ‡Department of Biostatistics, Boston University, Boston, Massachusetts. Received July 17, 2012; revision received September 14, 2012; accepted September 15, 2012. Supported in part by a research grant from the U.S. Department of Defense. Address correspondence to Sandeep Kumar, MD, Beth Israel Dea- coness Medical Center, Stroke Division, Department of Neurology, Palmer 127, 330 Brookline Ave, Boston, MA 02215. E-mail: skumar@ bidmc.harvard.edu. 1052-3057/$ - see front matter Ó 2014 by National Stroke Association http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.09.005 56 Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 1 (January), 2014: pp 56-62