Dysphagia

, Volume 29, Issue 3, pp 310–318 | Cite as

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

  • Amy Mandaville
  • Anjea Ray
  • Henry Robertson
  • Careen Foster
  • Christine Jesser
Original Article

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.

Keywords

Deglutition Deglutition disorders Clinical prediction model Long-term dysphagia Severe traumatic brain injury Percutaneous gastrostomy tube 

References

  1. 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.PubMedGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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. 4.
    Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil. 1985;66(6):372–5.PubMedGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 7.
    Robbins JA, Levine RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988;3(1):11–7.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 9.
    Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Linden P, Kuhlemeier KV, Patterson C. The probability of correctly predicting subglottic penetration from clinical observation. Dysphagia. 1993;8(3):170–9.PubMedCrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Winstein CJ. Neurogenic dysphagia: frequency, progression, and outcomes in adults following head injury. Phys Ther. 1983;63:1992–7.PubMedGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Lazarus C, Logemann J. Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil. 1987;68:79–84.PubMedGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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. 23.
    Hill K. Australian clinical guidelines for acute stroke management 2007. Int J Stroke. 2008;3(2):120–9.PubMedCrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 28.
    Brain Injury Association of America. The essential brain injury guide. 4th ed. McLean: Brain Injury Association of America; 2006.Google Scholar
  29. 29.
    The U.S. Centers for Disease Control and Prevention. http://www.cdc.gov/traumaticbraininjury/statistics.html. Accessed 4 Sept 2012.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Amy Mandaville
    • 1
  • Anjea Ray
    • 1
  • Henry Robertson
    • 2
  • Careen Foster
    • 3
  • Christine Jesser
    • 2
  1. 1.University Medical Center at BrackenridgeAustinUSA
  2. 2.Seton Family of Hospitals Analytics and Health EconomicsAustinUSA
  3. 3.Trauma TrustTacomaUSA

Personalised recommendations