A. Patel1, S. J. Amin1, P. P. Patel3, M. J. Anstadt3, V. C. Prabhu2, S. Pappu2 1Loyola University Chicago Stritch School Of Medicine,Maywood, IL, USA 2Loyola University Medical Center,Department Of Neurological Surgery,Maywood, IL, USA 3Loyola Medical Center,Department Of Trauma, Surgical Critical Care, And Burns,Maywood, IL, USA
Introduction: Aspiration and associated complications after cervical spine injury often have a devastating impact on patient outcomes. There are no guidelines regarding the utility of swallow evaluation to identify aspiration risk after cervical spine injury. We hypothesize that aspiration may be occurring at a significant rate even in patients who are not offered a swallow evaluation.
Methods: A single institution retrospective study was completed at an ACS verified Level 1 Trauma Center. The trauma registry was queried for patients with cervical spine injuries from 2014-2019. Data collected included demographics, comorbidities, injury details, completion of a swallow evaluation, and aspiration complications. Patients were divided into two groups based on clinical suspicion for dysphagia and were evaluated for aspiration using surrogate markers of cardiac complications, O2 desaturation, pneumonia, intubation, and death.
Results: 170 patients were diagnosed with a cervical spine fracture or cord injury. Patients who underwent swallow evaluation or had a dobhoff tube placed were considered to have a clinical suspicion for dysphagia and identified as the "dysphagia" group, which consisted of 64% of the study population. 36% of patients were considered not to have clinical suspicion for dysphagia and placed in the "no dysphagia" group. Patients in the dysphagia group compared to the no dysphagia group sustained the following complications at a rate of: cardiac 19% vs 18%, O2 desaturation 18% vs 8%, pneumonia 31% vs 6%, intubation 44% vs 19%, and death 16% vs 18%.
Conclusion: Aspiration related events occurred at comparable frequencies whether or not dysphagia was suspected. Clinical suspicion alone may not be sufficient to determine whether a patient has dysphagia and is at risk for aspiration. All patients with cervical spine injuries may be at risk for aspiration related complications and should be considered for formal swallow evaluation.
