Dysphagia and associated pneumonia in stroke patients from India

Abstract Background India has high incidence (116-163 per 100,000) of stroke compared to western countries. Stroke is reported to be the fourth leading cause of death and fifth leading cause of disability in India. Dysphagia is seen approximately in half of the stroke patients and if unidentified may result in pulmonary complications such as aspiration pneumonia. However, there is no estimate of post stroke dysphagia and associated pneumonia in India. Method Using the PRISMA methodology, a systematic search for recent literature on dysphagia in stroke was carried out across all the major databases. Two authors independently screened the titles and the abstracts, and those selected articles were assessed for quality using the GRADE approach. Comparisons were made of reported dysphagia and pneumonia frequencies, the relative risks of developing pneumonia were calculated. Data on duration of hospital stay and rates of mortality were also extracted. Results We identified 86 citations, out of which only four articles were deemed eligible for critical analyses and data extraction. A high incidence (11.1% - 87.5%) of dysphagia was observed among stroke patients. Only two studies reported on incidence of pneumonia (22.8% - 32%); only one study stratified patients by both dysphagia and pneumonia. A relative risk of 5.82 (95% CI 4.6, 7.2) was found for pneumonia in patients with stroke and dysphagia. Data on length of hospital stay and rates of mortality secondary to aspiration pneumonia are also presented. Conclusion Despite high incidence of dysphagia and associated pneumonia the methodological quality of studies are low. There is a dire need for methodologically sound studies to accurate determine the incidence of dysphagia and its impact on stroke patients in India.