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A Retrospective Review of Swallow Dysfunction in Patients with Severe Traumatic Brain Injury

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Abstract

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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References

  1. Lockett MA, Templeton ML, Byrne TK, Norcross ED. Percutaneous endoscopic gastrostomy complications in a tertiary care center. Am Surg. 2002;68(2):117–20.

    PubMed  Google Scholar 

  2. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications, and outcome. J Gastroenterol Hepatol. 2000;15(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  3. Gomes CA Jr, Lustosa SA, Matos D, Andriolo RB, Weisberg, Waisberg J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev. 2010;3:CD008096. doi:10.1002/14651858.CD008096.pub2.

    Google Scholar 

  4. Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil. 1985;66(6):372–5.

    CAS  PubMed  Google Scholar 

  5. Shaker R, Easterling C, Kern M, Nicshcke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patient with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(6):1314–21.

    Article  PubMed  Google Scholar 

  6. Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujui M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38:556–63.

    CAS  PubMed  Google Scholar 

  7. Robbins JA, Levine RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988;3(1):11–7.

    Article  CAS  PubMed  Google Scholar 

  8. Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL. Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev. 2006;43(3):301–9.

    Article  PubMed  Google Scholar 

  9. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.

    Article  CAS  PubMed  Google Scholar 

  10. Linden P, Kuhlemeier KV, Patterson C. The probability of correctly predicting subglottic penetration from clinical observation. Dysphagia. 1993;8(3):170–9.

    Article  CAS  PubMed  Google Scholar 

  11. Mackey LE, Morgan AS, Bernstein BA. Factors affecting oral feeding with severe traumatic brain injury. J Head Trauma Rehabil. 1999;14(5):435–47.

    Article  Google Scholar 

  12. Morgan A, Ward E, Murdoch B, Kennedy B, Murison R. Incidence, characteristics, and predictive factors for dysphagia after pediatric brain injury. J Head Trauma Rehabil. 2003;18(3):239–51.

    Article  PubMed  Google Scholar 

  13. Gurkin SA, Parikshak M, Kralovich KA, Horst HM, Agarwal V, Payne N. Indicators for tracheostomy in patients with traumatic brain injury. Am Surg. 2002;88(4):324–8.

    Google Scholar 

  14. Jung JJ, Kim DY, Kim YW, Koh YW, Joo SY, Kim ES. Effect of decannulation on pharyngeal and laryngeal movement in post-stroke tracheostomized patients. Ann Rehabil Med. 2012;36(3):356–64.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Winstein CJ. Neurogenic dysphagia: frequency, progression, and outcomes in adults following head injury. Phys Ther. 1983;63:1992–7.

    CAS  PubMed  Google Scholar 

  16. Halper AS, Cherney LR, Cichowski K, Zhang M. Dysphagia after head trauma: the effect of cognitive-communicative impairments on functional outcomes. J Head Trauma Rehabil. 1999;14(5):486–96.

    Article  CAS  PubMed  Google Scholar 

  17. Lazarus C, Logemann J. Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil. 1987;68:79–84.

    CAS  PubMed  Google Scholar 

  18. Mackey LE, Morgan AS, Bernstein BA. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. Arch Phys Med Rehabil. 1999;80:365–71.

    Article  Google Scholar 

  19. D’Amelio LF, Hammond JS, Spain DA, Sutyak JP. Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head-injured trauma patient. Am Surg. 1994;60(3):180–5.

    PubMed  Google Scholar 

  20. Ciaglia P, DeTraglia JJ. Comment on “Percutaneous tracheostomy/gastrostomy in brain injured patients–a minimally invasive alternative”. J Trauma. 1993;34(6):916–7.

    Article  CAS  PubMed  Google Scholar 

  21. Moore FA, Haenel JB, Moore EE, Read RA. Percutaneous tracheostomy/gastrostomy in brain-injured patients—a minimally invasive alternative. J Trauma. 1992;33(3):435–9.

    Article  CAS  PubMed  Google Scholar 

  22. Vaughn JR, Scott JS, Edelman DS, Unger SW. Tracheostomy: a new indication for percutaneous endoscopic gastrostomy tube placement. Am Surg. 1991;57(4):214–5.

    Google Scholar 

  23. Hill K. Australian clinical guidelines for acute stroke management 2007. Int J Stroke. 2008;3(2):120–9.

    Article  PubMed  Google Scholar 

  24. Ringleb PA, Bousser MG, Ford G, Bath P, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457–507.

    Article  Google Scholar 

  25. Jørgensen HS, Reith J, Nakayama H, Kammersgaard LP, Raaschou HO, Olsen TS. What determines good recovery in patients with the most severe strokes. Stroke. 1999;30:2008–12.

    Article  PubMed  Google Scholar 

  26. Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, Deitch EA, Livingston DH. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907–11.

    Article  PubMed  Google Scholar 

  27. Chantal WP, Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, Murray GD, Mass AI. Patient age and outcome following severe traumatic brain injury: an analysis of 5,600 patients. J Neurosurg. 2003;99(4):666–73.

    Article  Google Scholar 

  28. Brain Injury Association of America. The essential brain injury guide. 4th ed. McLean: Brain Injury Association of America; 2006.

    Google Scholar 

  29. The U.S. Centers for Disease Control and Prevention. http://www.cdc.gov/traumaticbraininjury/statistics.html. Accessed 4 Sept 2012.

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Acknowledgments

The authors thank medical students Bryan K. Lai and David Keith, who contributed to data collection in the study.

Disclosure

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. University Medical Center at Brackenridge, 601 E. 15th Street, Austin, TX, 78701, USA

    Amy Mandaville & Anjea Ray

  2. Seton Family of Hospitals Analytics and Health Economics, 1345 Philomena Street, Austin, TX, 78723, USA

    Henry Robertson & Christine Jesser

  3. Trauma Trust, 315 Martin Luther King Jr. Way, Tacoma, WA, 98405, USA

    Careen Foster

Authors
  1. Amy Mandaville
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  2. Anjea Ray
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  3. Henry Robertson
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  4. Careen Foster
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  5. Christine Jesser
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Correspondence to Amy Mandaville.

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Mandaville, A., Ray, A., Robertson, H. et al. A Retrospective Review of Swallow Dysfunction in Patients with Severe Traumatic Brain Injury. Dysphagia 29, 310–318 (2014). https://doi.org/10.1007/s00455-013-9509-2

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  • DOI: https://doi.org/10.1007/s00455-013-9509-2

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