J. C. Lee1, A. Vellucci1, B. W. Gross1, K. J. Rittenhouse1, C. Morrison1, F. B. Rogers1 1Lancaster General Hospital,Trauma,Lancaster, PENNSYLVANIA, USA
Introduction: Severe cervical spine (c-spine) injuries requiring rigid immobilization are associated with high rates of dysphagia and complications. Research suggests a geriatric predisposition to this complication. We sought to compare the incidence of dysphagia in the geriatric and general population for patients with c-spine injuries and propose an aggressive screening program that aims to decrease morbidity.
Methods: All trauma admissions to a level II trauma center from January 2010 to April 2014 with c-spine injuries were retrospectively reviewed. C-spine injury was classified as any ligamentous or vertebral body fracture. Patients were considered to have signs of dysphagia if a speech evaluation and/or a barium swallow (VFSS) was conducted, indicating a failure of preliminary bedside nursing assessment. The relationship between dysphagia development and age was assessed using X2 analysis (significance p<0.05). Development of pneumonia was considered a complication.
Results: Over the four-year study period, 537 c-spine injured patients were admitted. Of this, 144 total patients (26.8%) exhibited signs of dysphagia, 105 (72.9%) of which were geriatric and 39 (27.1%) general. Geriatric patients were found to be associated with higher rates of speech evaluation (p<0.001) and barium swallow (p=0.022), while the general population was associated with higher rates of pneumonia (p=0.021) (Table 1).
Conclusion: The high rate of speech evaluation and even higher incidence of formal contrast swallow studies in the geriatric population suggests a significant presence of dysphagic symptoms following c-spine injury. The low prevalence of pneumonia in the geriatric population may reflect the preventative measures taken due to heightened awareness of this susceptible population. Therefore, a formal speech therapy evaluation for dysphagia should be strongly considered in all trauma patients with c-spine injuries, and mandatory for those over the age of 65.
