Medical Student Icahn School of Medicine at Mount Sinai New York City, New York, United States
Introduction: Laryngeal manifestations of stroke, though rare, are associated with increased morbidity. Vocal fold paralysis (VFP) has been understudied in the stroke literature. Intracerebral hemorrhage (ICH) represents 10-15% of all strokes, with a significant knowledge gap surrounding the trends of patients with VFP after ICH. This study aimed to identify the incidence and characteristics of patients presenting with VFP after ICH.
Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of VFP on outcomes. Significance set at an alpha level of < 0.001. All analysis performed in R version 4.1.3.
Results: 2,000,868 patients with ICH were included; 2,132 (0.1%) had in-hospital VFP. A greater percentage of patients with VFP were younger, had higher Elixhauser Comorbidity Score, higher NIH Stroke Scale (NIHSS) score, have private insurance, and were treated at urban teaching hospitals (all p< 0.001). After propensity matching, these patients were less likely to experience in-hospital mortality (AOR 0.53; 95%CI: 0.34-0.79; p=0.002) with longer hospital stays (1.99 days; 95%CI: 1.78-2.21; p< 0.001).
Conclusion : In this 20-year national propensity matched analysis of patients with ICH, patients with VFP were younger with worse neurological presentations. Though VFP was associated with increased in-hospital survival, patients had longer hospital stays. Further analysis to characterize these risk factors and association of VFP and ICH is warranted to improve patient outcomes.
