Dysphagia Management in Military Service Members With Polytrauma: Overview and Case Report

Abstract

Purpose At Walter Reed National Military Medical Center, service members (SMs) with polytraumatic injuries, usually resulting from blast explosions, are routinely referred to the Speech Pathology Clinic for evaluation of swallowing function. The purpose of this clinical focus article is to advance the speech-language pathologist's (SLP) knowledge of polytrauma and to improve the care of individuals with traumatic injuries, especially related to nutrition and swallowing within a larger multidisciplinary team approach. Case Report Previous research within our center identified common demographic and injury characteristics of SMs with combat-related injuries that led to referrals for swallowing evaluation. An SM with polytraumatic injuries was selected for this case report to illustrate the relevance of the research findings and also the importance of multidisciplinary team support to appropriately manage such complex cases. Evaluations and relevant treatments are described across a 3-month acute care hospitalization, including swallowing and nutritional recommendations at the time of each swallowing evaluation. Discussion Comparisons of polytrauma cases at Walter Reed National Military Medical Center with literature from civilian trauma centers revealed somewhat longer hospitalizations and the particular influence of maxillofacial trauma on dysphagia outcomes. The complex case reported in this article illustrates the importance of multidisciplinary care and coordination, with particular emphasis on the intersecting roles of the SLP and registered dietitian. This report can serve as a guide for SLPs working in trauma settings for developing prognostic statements, treatment plans, and multidisciplinary interaction.