Dysphagia in patients with severe stroke: influencing factors and coping strategies

Background Dysphagia is a common and serious complication in patients with severe stroke. This study aimed to identify independent risk factors for dysphagia in this population, construct a predictive model, and provide evidence-based support for risk stratification. Methods A retrospective cohort study was conducted on patients with severe stroke admitted to the Neurointensive Care Unit (NICU) of a Grade A tertiary hospital from January 2023 to August 2025. Patients were divided into a dysphagia group ( n = 288) and a non-dysphagia group ( n = 70) based on swallowing assessment. Clinical data were collected and compared. Results Among 358 patients with severe stroke, the incidence of dysphagia was 80.45%. Logistic regression identified age ≥70 years (OR = 6.452, 95%CI: 3.825–10.936), brainstem/basal ganglia lesion location (OR = 4.608, 95%CI: 2.751–7.723), GCS score ≤8 points (OR = 8.654, 95%CI: 5.012–14.928), mechanical ventilation use (OR = 6.863, 95%CI: 4.015–11.729), and sedative use (OR = 5.382, 95%CI: 3.156–9.187) as independent risk factors. A predictive model based on these five factors yielded an area under the ROC curve of 0.864 (95%CI: 0.812–0.916, p < 0.001). Conclusion Dysphagia occurs in over 80% of patients with severe stroke. The proposed model, using readily available clinical variables, shows potential for early risk identification. However, external validation in prospective multicenter cohorts is required before routine clinical application.