Abstract
Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.
Highlights
Post-extubation dysphagia is a common complication in mixed intensive care units (ICUs), causing aspiration pneumonia, malnutrition, and dehydration, and increasing the length of hospital stay and mortality [1,2,3,4,5]
Exclusion criteria were as follows: [1] patients with primary laryngopharyngeal diseases, laryngopharyngeal mass, or any other situation leading to dysphagia before enrollment; [2] patients who could not be extubated or with tracheotomy; [3] patients who rejected to participated in standardized swallowing assessment (SSA) for any reason; and [4] patients who failed to finish the first SSA (e.g., Some patients were not allowed to drink or eat due to their condition) or failed to complete all the follow up (e.g., Some patients were thought that the SSA was cumbersome and they were unwilling to participate again after the first test)
Age, diagnostic category, hypertension, neurointensive care unit (NICU) stay, mechanical ventilation, protective restraint, nasogastric feeding tube, tracheal intubation, sedation, relaxants, muscle strength grade, Richmond Agitation-Sedation Scale (RASS) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were significantly different between the two groups
Summary
Post-extubation dysphagia is a common complication in mixed intensive care units (ICUs), causing aspiration pneumonia, malnutrition, and dehydration, and increasing the length of hospital stay and mortality [1,2,3,4,5]. The prevalence of postextubation dysphagia ranges from 3 to 62%, which leads to increased healthcare-related costs [6, 7]. The condition is even worse in patients with neurological diseases. In addition to neuromuscular disease, acquired neurological disease is a high risk for dysphagia. Even in patients with a non-traumatic subarachnoid hemorrhage, the incidence of dysphagia is 16.33% [10]. Previous clinical studies have identified neurological diseases as a significant risk factor for the development of dysphagia [11, 12]. Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery
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