Swallowing problems occur in 37-78 % of stroke patients. Evidence points to multiple factors contributing to the development of pneumonia in the first week post stroke, of which the presence of dysphagia is one. A heightened understanding of the very acute phase (first 7 days post stroke) is required to improve management of this population. We conducted a retrospective review of 536 stroke patients admitted to Australian hospitals in 2010. Data were collected on 37 clinical and demographic parameters. Descriptive statistics and univariate and multivariate logistic regression analyses were performed. Dysphagia was present in 58.5 % of admissions. For those patients remaining in the study for the full week there was a recovery rate from dysphagia of 30.5 %. Overall incidence of respiratory infection was 11 %. Respiratory infections developed in 17 % of patients with dysphagia. Impaired Glasgow Coma Scale, ischemic stroke, and significantly impaired mobility were associated with swallowing difficulties. Being nil by mouth and insertion of a nasogastric tube were significant predictors for respiratory infections. This study of a large cohort of acute stroke patients supports research indicating that aspiration pneumonia is multifactorial in nature and the incidence of respiratory infection is significant in the very acute stroke period.