Dysphagia in acute tetraplegics: a retrospective study

Abstract

Study design: Retrospective study. Objectives: Swallowing disorder in patients with tetraplegia represents a problem. Incidence and clinical data were examined to determine the influencing factors. Setting: Level I trauma Center, Berlin, Germany. Method: Retrospective study (1 September 1997-31 December 2002) on hospitalized patients with acute tetraplegia. The patients' swallowing ability was examined both clinically and endoscopically, and the results correlated with clinical data. Results: A total of 175 patients (144 (82.29%) male patients and 31 (17.71%) female patients (4.6:1) were studied. The peak age groups (43.45, ± 18.98, 14-89 years) were 20-30 years and over 60 years. C4-C6 were most commonly affected. Tetraplegia was trauma-related in 147 (84%) patients. Twentyeight (16.0%) patients appeared to be suffering from a swallowing disorder on first feeding, 23 (82.14%) patients with dysphagia were tracheotomized. The level of tetraplegia (w 2 ¼ 19.8; Po0.05), tracheotomy (w 2 ¼ 21.7; Po0.05) and the duration of ventilation (w 2 ¼ 24.84, Po0.05) were all found to be statistically significant factors in the development of a swallowing disorder. Age, surgical approach, level of tetraplegia, severity of paralysis and the need for tracheotomy were predictive of dysphagia in 73.14% patients. Five patients with dysphagia died (because of causes other than dysphagia) and 10 patients were discharged with a feeding tube. Conclusion: No single trigger for a swallowing disorder in acute tetraplegia was found. A combination of multiple factors (level of tetraplegia, severity of paralysis, tracheotomy, accompanying injuries and accompanying illnesses) restricts swallowing and compensation of changes, to the extent that a swallowing disorder becomes apparent.

Dysphagia in cervical spinal cord injury

“…Age was found to be statistically related to dysphagia by Kirshblum et al, 7 but not by Wolf and Meiners, 2 Abel et al 8 or Seidl et al 9 In the present study, the mean age of patients with aspiration was significantly higher compared with the patients without evidence of aspiration. Even linear by linear association after categorization in different age groups showed higher prevalence of dysphagia with increasing age.…”

“…This correlation was also supported in previous studies. 2,[7][8][9] Although the cause-effect relationship between dysphagia and the need for tracheostomy is unclear, various reports of increased risk of dysphagia through tracheostomy give weight to the possibility that risk of dysphagia increases through the existence of tracheostomy in cervical spinal cord injury patients. This was also evident in the present study, as the incidence of aspiration was significantly related to the presence of tracheostomy by the time of VFSS, but not to the history of tracheostomy.…”

“…Moreover, the authors classified the type of dysphagia into oral, pharyngeal and esophageal dysphagia according to the VFSS findings. Seidl et al 9 reported that 175 cervical spinal cord injury patients underwent FEES and 28 patients were diagnosed with dysphagia. Moreover, the authors reported that besides history of tracheostomy, no other clinical factor was significantly associated with dysphagia.…”

Respiratory problems and management in people with spinal cord injury

“…Other considerations such as co-operation of the patient, oxygen requirements, medical stability, presence of respiratory infection or pending surgery should be taken into account [131, 132]. As the incidence of aspiration is moderately high in acute tetraplegia (16–41%), speech pathology assessment is required [133, 134]. Speaking valve use during oral intake has been shown to decrease aspiration risk in nonventilated patients [135] and persistent aspiration following cervical SCI may not be an obstacle to decannulation if a risk management approach is taken [136].…”

Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting

“…The incidence of dysphagia with acute tetraplegia post‐SCI has been previously reported as variable but common (16–41%) (Seidl et al . , Shem et al . ); only one patient in the study was unable to commence oral intake early, with dysphagia related to a neuropraxic injury to the recurrent laryngeal nerve sustained during anterior cervical surgery.…”