Prediction of Total Oral Intake by Videoendoscopic Evaluation in Patients With Acute Stroke

Background: Post-stroke dysphagia is common and is linked to adverse clinical outcomes. The Hyodo-Komagane (H-K) score is an endoscopic index of dysphagia severity used during flexible endoscopic evaluation of swallowing (FEES) in Japan. However, its value for predicting oral intake outcome in acute stroke has not been fully established. Objective: This study aimed to investigate whether the H-K score assessed during acute stroke is associated with oral diet (OD) at discharge after rehabilitation. Methods: We retrospectively reviewed 137 patients with acute stroke who underwent FEES between September 2018 and March 2020 at the Hirosaki Stroke and Rehabilitation Center in Hirosaki, Japan. According to oral intake status at discharge, patients were assigned to either an OD group or a tube feeding (TF) group. Multivariable logistic regression was performed to identify factors independently associated with OD at discharge. Predictive ability was also evaluated using receiver operating characteristic analysis for age, National Institutes of Health Stroke Scale (NIHSS) score at admission, and H-K score. Results: Of the 137 patients, 107 were classified into the OD group and 30 into the TF group. The OD group was younger and showed lower NIHSS and H-K scores than the TF group. In the multivariable analysis, age (odds ratio (OR), 0.94; 95% confidence interval (CI), 0.88-0.99; p = 0.02), NIHSS score at admission (OR, 0.93; 95% CI, 0.88-0.99; p = 0.02), and H-K score (OR, 0.56; 95% CI, 0.41-0.74; p < 0.0001) were independently associated with OD at discharge. The area under the curve was 0.655 for age, 0.666 for NIHSS score, and 0.810 for H-K score. The optimal cutoff value for the H-K score was 5, with 0.64 sensitivity and 0.84 specificity. A model combining age and H-K score showed an area under the curve of 0.835. Conclusions: In patients with acute stroke and dysphagia who underwent FEES, the H-K score was associated with OD at discharge and showed the best predictive performance among the evaluated variables. Adding age provided only a small incremental improvement. The H-K score may be a useful bedside parameter for estimating OD outcome in acute stroke.