Commentary: Early screening parameters for dysphagia in acute ischemic stroke

We read with great interest the article by Henke et al. (1) aimed to identify early assessable predictors of dysphagia in the acute phase of ischemic stroke. A multivariate logistic regression analysis revealed higher age, male gender, and higher stroke severity [as assessed by NIH stroke scale (NIHSS)] to be independent predictor of poststroke dysphagia. Moreover, ROC analysis showed that in the acute phase of stroke NIHSS score of 4.5 was the best cut-off between dysphagic and non-dysphagic patients. This research field certainly has a remarkable clinical interest, because it may lead to individuate those acute stroke patients who may benefit from a more detailed assessment of their swallow function (i.e., using fiberoptic endoscopic evaluation of swallowing or videofluoroscopy). However, an NIHSS cut-off for dysphagia of 4.5, by excluding only stroke patients with a very mild deficit, is probably of limited clinical usefulness. In other words, since the majority of stroke is of moderate-severe degree, it appears to be of little help in detecting only those patients who may benefit from a more detailed assessment of their swallowing function.