Wojner and Alexandrov identified predictors associated with the need for placing a feeding tube in a stroke patient with dysphagia. These can help identify a patient who may benefit from more aggressive management to prevent complications. The authors are from the University of Texas at Houston.


Predictors for enteral tube placement:

(1) presence of a "wet voice" after swallowing water

(2) hypoglossal nerve dysfunction

(3) high National Institute of Health Stroke Scale (NIHSS)

(4) incomplete oral labial closure



• Incomplete oral labial closure (putting the lips together) is an indicator of facial nerve motor tone (Table 1, page 533).

• The NIHSS ranges from 0 to 36, with a high score indicating a more severe stroke.

• The glossopharyngeal nerve is evaluated based on lateral, anterior and posture tongue movements and the ability to elevate the tongue against the hard palate (Table 1, page 533).


Odds Ratio for Feeding Tube

hypoglossal nerve dysfunction



1.24 * (NIHSS)

wet voice after water


incomplete oral labial closure




• The odds ratio for NIHSS is given on page 537 (1.24 times each NIHSS point score). An alternative is to raise 1.24 to a power equal to the NIHSS; an NIHSS score of 36 would indicate an odds ratio of 2307. Multiplying 1.24 * 36 = 45.


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