Dysphagia among geriatric trauma patients: A population-based study.

Kenny Nieto,Huazhi Liu,Darwin Ang,Claudio Andaloro

doi:10.1371/journal.pone.0262623

Abstract

ObjectiveTo determine the significance of dysphagia on clinical outcomes of geriatric trauma patients.MethodsThis is a retrospective population-based study of geriatric trauma patients 65 years and older utilizing the Florida Agency for Health Care Administration dataset from 2010 to 2019. Patients with pre-admission dysphagia were excluded. Multivariable regression was used to create statistical adjustments. Primary outcomes included mortality and the development of dysphagia. Secondary outcomes included length of stay and complications. Subgroup analyses included patients with dementia, patients who received transgastric feeding tubes (GFTs) or tracheostomies, and speech language therapy consultation.ResultsA total of 52,946 geriatric patients developed dysphagia after admission during a 9-year period out of 1,150,438 geriatric trauma admissions. In general, patients who developed dysphagia had increased mortality, length of stay, and complications. When adjusted for traumatic brain and cervical spine injuries, the addition of mechanical ventilation decreased the mortality odds. This was also observed in the subset of patients with dysphagia who had GFTs placed. Of the three primary risk factors for dysphagia investigated, mechanical ventilation was the most strongly associated with later development of dysphagia and mortality.ConclusionThe geriatric trauma population is vulnerable to dysphagia with a large number associated with traumatic brain injury, cervical spine injury, and polytraumatic injuries that lead to mechanical ventilation. Earlier intubation/mechanical ventilation in association with GFTs was found to be associated with decreased inpatient hospital mortality. Tracheostomy placement was shown to be an independent risk factor for the development of dysphagia. The utilization of speech language therapy was found to be inconsistently utilized.

Highlights

Geriatric trauma patients are of particular interest in trauma research due in part to the increasingly larger proportion of trauma patients they represent in the United States
When adjusted for traumatic brain and cervical spine injuries, the addition of mechanical ventilation decreased the mortality odds. This was observed in the subset of patients with dysphagia who had GFTs placed
Of the three primary risk factors for dysphagia investigated, mechanical ventilation was the most strongly associated with later development of dysphagia and mortality

Summary

Introduction

What may be considered minor mechanisms of injury in younger patients may have far greater deleterious consequences to patients of advanced age who are typically frailer. Many geriatric patients are exposed to polypharmacy and suffer from the cumulative effects of chronic medical conditions including neuromuscular disorders, dementia, presbycusis, and vision impairment [1, 2]. Traumatic brain injury (TBI), cervical spine injury (CSI), and need for mechanical ventilation have been shown to be independent risk factors for the development of dysphagia [3, 4]. Dysphagia may be cited as a complication or sequelae of trauma and non-traumatic conditions such as neurodegenerative disorders and malignancy, or in association with operative procedures (e.g., anterior approach for the repair of cervical spine injuries) [3]. The mechanisms, signs, and symptoms of dysphagia for each etiology are variable among patients

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Conclusion