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.