Research Reports - A retrospective review of swallow dysfunction in patients with severe traumatic brain injury

Dysphagia. 2014 Jan 12

Mandaville A, Ray A, Robertson H, Foster C, Jesser C

In the acute-care setting, it is difficult for clinicians to determine which
patients with severe traumatic brain injury will have long-term oropharyngeal
dysphagia (>6 weeks) and which patients will begin oral nutrition quickly.
Patients frequently remain in the acute-care setting while physicians determine
whether to place a percutaneous endoscopic gastrostomy (PEG) tube. To improve the
acute-care clinician's ability to predict long-term oropharyngeal dysphagia and
subsequent need for PEG tube placement in patients with severe traumatic brain
injury [Glascow Coma Scale (GCS) ≤8), a novel prediction model was created
utilizing clinical information and acute-care swallowing evaluation findings.
Five years of retrospective data were obtained from trauma patients at a Level 1
trauma hospital. Of the 375 patients who survived their hospitalization with a
GCS ≤8, a total of 269 patients received Ranchos Los Amigos (RLA) scores. Of
those patients who were scored for RLA, 219 patients underwent swallowing
evaluation. Ninety-six of the 219 patients were discharged from the hospital with
a feeding tube, and 123 patients were discharged without one. Logistic regression
models examined the association between clinical and patient characteristics and
whether a patient with severe traumatic brain injury exhibited long-term
oropharyngeal dysphagia. Multivariable logistic regression analysis revealed that
increased age, low RLA score, tracheostomy tube placement, and aphonia observed
on the initial swallowing evaluation significantly increased the odds of being
discharged from the acute-care hospital with a feeding tube. The resultant model
could be used clinically to guide decision making and to counsel patients and
families.

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