BACKGROUND: The clinical significance of post-extubation swallowing dysfunction (PSD) is profound, resulting in both increased morbidity and mortality. Specific risk factors have not been described in an injured patient cohort. The purpose of this pilot study was to elucidate independent factors that predict PSD in this population. METHODS: A retrospective cohort analysis was performed on 150 consecutive trauma patients intubated for more than 48 hours. Assessment of swallowing function after extubation was performed by a simple bedside speech pathology evaluation. Patients then were divided into 2 groups: those with and those without PSD. Backwards stepwise logistic regression analysis then was used to determine independent predictors of PSD after controlling for important injury characteristics and patient demographics. RESULTS: The incidence of PSD in our study cohort was 41%. Patients with PSD, although older than non-PSD patients (48 vs 37.5 y; P = .001), were similar with respect to admission Glasgow coma score (GCS) and injury severity score. Regression analysis revealed that age older than 55 years (odds ratio, 2.60; P = .037; 95% confidence interval, 1.1-6.4) and ventilator days (odds ratio, 1.14; P = .001; 95% confidence interval, 1.1-1.2) were significant independent risk factors for PSD. Interpretation of these odds ratios revealed that those patients older than age 55 had more than a 2.5-fold greater risk of PSD. The risk increased by 14% for every day a patient required intubation. There was no significant association between PSD and injury severity score, GCS, presence of medical comorbidities, or development of nosocomial pneumonia. CONCLUSIONS: PSD is a common occurrence in trauma patients. Age older than 55 years and ventilator days are independent risk factors for PSD. Injury severity, altered GCS upon arrival, comorbidities, and nosocomial pneumonia were not independent risk factors for PSD in our cohort. These results suggest that older patients with extended intensive care unit stays and ventilator requirements may benefit from early swallowing evaluation.
BACKGROUND: The clinical significance of post-extubation swallowing dysfunction (PSD) is profound, resulting in both increased morbidity and mortality. Specific risk factors have not been described in an injured patient cohort. The purpose of this pilot study was to elucidate independent factors that predict PSD in this population. METHODS: A retrospective cohort analysis was performed on 150 consecutive traumapatients intubated for more than 48 hours. Assessment of swallowing function after extubation was performed by a simple bedside speech pathology evaluation. Patients then were divided into 2 groups: those with and those without PSD. Backwards stepwise logistic regression analysis then was used to determine independent predictors of PSD after controlling for important injury characteristics and patient demographics. RESULTS: The incidence of PSD in our study cohort was 41%. Patients with PSD, although older than non-PSDpatients (48 vs 37.5 y; P = .001), were similar with respect to admission Glasgow coma score (GCS) and injury severity score. Regression analysis revealed that age older than 55 years (odds ratio, 2.60; P = .037; 95% confidence interval, 1.1-6.4) and ventilator days (odds ratio, 1.14; P = .001; 95% confidence interval, 1.1-1.2) were significant independent risk factors for PSD. Interpretation of these odds ratios revealed that those patients older than age 55 had more than a 2.5-fold greater risk of PSD. The risk increased by 14% for every day a patient required intubation. There was no significant association between PSD and injury severity score, GCS, presence of medical comorbidities, or development of nosocomial pneumonia. CONCLUSIONS:PSD is a common occurrence in traumapatients. Age older than 55 years and ventilator days are independent risk factors for PSD. Injury severity, altered GCS upon arrival, comorbidities, and nosocomial pneumonia were not independent risk factors for PSD in our cohort. These results suggest that older patients with extended intensive care unit stays and ventilator requirements may benefit from early swallowing evaluation.
Authors: James C Borders; Daniel Fink; Joseph E Levitt; Jeffrey McKeehan; Edel McNally; Alix Rubio; Rebecca Scheel; Jonathan M Siner; Stephanie Gomez Taborda; Rosemary Vojnik; Heather Warner; S David White; Susan E Langmore; Marc Moss; Gintas P Krisciunas Journal: Dysphagia Date: 2019-01-29 Impact factor: 3.438
Authors: R S Ambika; Badari Datta; B V Manjula; Unmesh V Warawantkar; Anita Mariet Thomas Journal: Indian J Otolaryngol Head Neck Surg Date: 2018-03-05
Authors: Fernanda Chiarion Sassi; Ana Paula Ritto; Maíra Santilli de Lima; Cirley Novais Valente Junior; Paulo Francisco Guerreiro Cardoso; Bruno Zilberstein; Paulo Hilário Nascimento Saldiva; Claudia Regina Furquim de Andrade Journal: PLoS One Date: 2022-06-16 Impact factor: 3.752