Stroke is one of the leading causes of mortality and long-term disability worldwide and represents a major public health concern. Neurological deficits following stroke often lead to a variety of complications that can significantly affect patient recovery and quality of life. Among these complications, dysphagia, or difficulty in swallowing, is one of the most common and clinically significant conditions observed in stroke patients (1).

Post-stroke dysphagia occurs as a result of neurological impairment affecting the complex coordination of the swallowing mechanism. Damage to cortical, subcortical, or brainstem regions that regulate swallowing can disrupt the normal process of food and liquid passage from the mouth to the oesophagus. As a result, patients may experience difficulty in swallowing, choking, or aspiration (2).

This condition is of particular clinical concern because it increases the risk of several serious complications, including aspiration, malnutrition, dehydration, and aspiration pneumonia. Among these, aspiration pneumonia is one of the most severe outcomes and is associated with prolonged hospital stay, increased healthcare costs, and higher mortality rates (3).

Several factors have been identified as potential predictors of post-stroke dysphagia, including stroke severity, brainstem involvement, advanced age, hemorrhagic stroke, and reduced level of consciousness (4). Despite its significant impact on patient outcomes, dysphagia often remains under-recognized in clinical practice. Therefore, the present study was undertaken to determine the incidence, predictors, and clinical outcomes associated with post-stroke dysphagia in patients admitted with acute stroke.

Study Design Cross-sectional descriptive study. Study Population Patients admitted with acute stroke to a tertiary care hospital (Kalinga Institute of Medical Sciences, Bhubaneswar) over a period of 1 year from January 2025 to December 2025 Sample Size 445 patients. Inclusion Criteria • Patients aged ≥18 years • Confirmed diagnosis of stroke (ischemic or haemorrhagic) by CT or MRI • Admission within 48 hours of stroke onset Exclusion Criteria • Pre-existing swallowing disorders • Neurodegenerative diseases affecting swallowing • Previous head and neck surgery • Patients with a Glasgow Coma Scale (GCS) score <12 or those unable to follow simple verbal commands were excluded, as patients need to be sufficiently alert and able to comply with examiner instructions during dysphagia screening. Dysphagia was identified using the Gugging Swallowing Screen (GUSS) screening tool. All stroke patients underwent systematic dysphagia screening using GUSS, without confirmatory instrumental evaluation (such as video fluoroscopic swallowing study). During hospitalization, patients were evaluated daily for clinical signs suggestive of pneumonia by the treating physician. Whenever pneumonia was suspected, appropriate diagnostic investigations and treatment were initiated. After discharge, patients were followed for up to three months through telephone contact and in-person visits. Information was collected regarding oral feeding status, removal of the nasogastric tube, symptoms of aspiration, clinical features suggestive of pneumonia, hospital readmission, and mortality. Death was considered pneumonia-related when fever, cough, and respiratory distress were present at the time of death. Demographic details, clinical examination findings, modified Rankin Scale (mRS) scores, and GCS scores were obtained directly from the patients. Statistical Analysis Software for statistical analysis was used. Frequencies and percentages were used to represent categorical variables. The Chi-square test was used to evaluate the relationship between the variables. A significance level of p <0.05 was deemed statistically significant.

Table 1: Clinico-demographic details of study participants (n = 445)

Table 2: Impact of Dysphagia on Pneumonia

Figure 1: Incidence of Dysphagia by Stroke Type

Figure 2: Impact of Dysphagia on Pneumonia

Table 3: Clinical Outcomes According to Post-Stroke Dysphagia Status at 3-Month Follow-up (n = 445)

Table 4: Predictors of Post-Stroke Dysphagia (Multivariate Logistic Regression Analysis, n = 445)

The present study evaluated the prevalence, predictors, and clinical consequences of post-stroke dysphagia in 445 acute stroke patients and demonstrated a strong association between dysphagia and adverse short-term outcomes. Post-stroke dysphagia was identified in 320 patients (71.9%), confirming that swallowing dysfunction is a frequent neurological complication after stroke and an important contributor to morbidity, mortality, prolonged hospitalization, and healthcare burden. A large proportion of the study population was elderly, with 47.4% aged above 65 years. Advanced age was significantly associated with dysphagia, which may be explained by age-related decline in neuromuscular coordination, delayed swallowing reflexes, and reduced physiological reserve. Although males constituted 60.2% of the cohort, gender was not a statistically significant predictor, in agreement with previous studies. (5).

Ischemic stroke was the most common subtype (70.1%); however, when incidence was assessed within stroke categories, dysphagia was more frequent in hemorrhagic stroke than ischemic stroke (79.7% vs 68.6%, p<0.001). Hemorrhagic stroke may produce larger lesions, cerebral edema, impaired consciousness, and more severe neurological deficits, thereby increasing swallowing dysfunction. Lower GCS scores were also strongly associated with dysphagia, emphasizing the relationship between reduced sensorium and impaired airway protection. Stroke location played an important role. Patients with bilateral hemispheric and brainstem lesions had significantly higher dysphagia rates. This finding is biologically plausible because the swallowing network depends on bilateral cortical input and intact brainstem nuclei coordinating pharyngeal and esophageal phases of swallowing. Damage to these regions often results in severe or prolonged dysphagia. (6).

The severity of dysphagia also influenced outcomes. Moderate to severe dysphagia accounted for a substantial proportion of cases, highlighting the need for early bedside swallowing assessment and specialist referral. Most patients developed dysphagia within 24 hours of stroke onset, reinforcing the importance of routine early screening in acute stroke units. Vascular risk factors such as hypertension, diabetes mellitus, smoking, coronary artery disease, and dyslipidaemia were more common among dysphagic patients, suggesting that chronic vascular disease may predispose to more severe cerebrovascular injury and poorer neurological recovery. Feeding requirements reflected clinical burden, with only 55.1% managed by oral feeding, while 36% required nasogastric tube support. (7).

A major finding was the strong association between dysphagia and aspiration pneumonia. Based on comparative analysis, pneumonia occurred significantly more often in dysphagic patients than non-dysphagic patients (59.4% vs 36.0%, p<0.001). Dysphagia was also linked with malnutrition, recurrent hospitalization, higher mortality, and poorer functional outcomes at 3 months. Favorable recovery was substantially lower among patients with dysphagia. Overall, 60.2% of patients improved, 27.2% had persistent dysphagia, and mortality remained considerable. These findings underscore that post-stroke dysphagia is not merely a transient symptom but a clinically significant predictor of worse prognosis. Early screening, multidisciplinary swallowing rehabilitation, nutritional optimization, and aspiration prevention strategies are essential to improve survival and functional recovery after stroke. (8).

A common consequence that affects almost one-third of stroke patients is post-stroke dysphagia. To lower complications and enhance clinical results, all stroke patients should have routine early screening and proper dysphagia care. Hemorrhagic stroke and severe stroke are strong predictors of dysphagia. Dysphagia significantly increases the risk of aspiration pneumonia and unfavorable A common consequence that affects almost one-third of stroke patients is post-stroke dysphagia. To lower complications and enhance clinical results, all stroke patients should have routine early screening and proper dysphagia care. Hemorrhagic stroke and severe stroke are strong predictors of dysphagia. Dysphagia significantly increases the risk of aspiration pneumonia and unfavorable clinical outcomes.

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