Decoupling of swallowing and motor recovery after aneurysmal subarachnoid hemorrhage: prognostic value of acute functional oral intake scale score for long-term tube dependence.

BACKGROUND: Functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH) are traditionally defined using the modified Rankin Scale (mRS), often overlooking specific deficits such as dysphagia. We aimed to determine the prevalence of persistent dysphagia at rehabilitation discharge and identify early predictors of tube dependence.

METHODS: We analyzed 82 consecutive patients with aSAH managed from ictus to rehabilitation discharge at a single integrated facility (2018-2024). Acute swallowing function was assessed using the Functional Oral Intake Scale (FOIS) at a median of 28 days post-onset. The primary endpoint was tube-feeding dependence at rehabilitation discharge.

RESULTS: Persistent dysphagia occurred in 26% of patients. Notably, swallowing recovery did not strictly parallel motor recovery; 13% of patients with severe disability (mRS score 5) achieved oral autonomy. Multivariable analysis identified older age (odds ratio [OR], 1.2 per supplementary year of age; 95% confidence interval [CI], 1.05-1.55), poor World Federation of Neurological Societies grade (OR, 18.1; 95% CI, 1.08-1056.20), requirement for tracheostomy (OR, 17.5; 95% CI, 1.56-537.55), and lower acute FOIS scores (OR, 0.1 per supplementary point; 95% CI, 0.00-0.36) as independent predictors of the endpoint. Receiver operating characteristic analysis established an acute FOIS score ≤2 as a robust predictor (area under the curve: 0.95; sensitivity: 95.2%).

CONCLUSIONS: Nearly one-quarter of aSAH survivors remain tube-dependent at rehabilitation discharge. An acute FOIS score ≤2 serves as a decisive marker for early gastrostomy planning. Crucially, a predicted poor motor outcome should not preclude aggressive swallowing rehabilitation, as oral intake potential persists even in severe disability.