TY - JOUR
T1 - Prevalence, recovery, and factors associated with dysphagia in an older critically ill trauma cohort
T2 - A cross-sectional study
AU - Freeman-Sanderson, Amy
AU - Crisp, Janae
AU - Hodgson, Carol L.
AU - Holland, Anne E.
AU - Harrold, Meg
AU - Chan, Terry
AU - Tipping, Claire J.
N1 - Funding Information:
The Victorian State Trauma Registry (VSTR) is a Department of Health and Human Services, State Government of Victoria and Transport Accident Commission–funded project. The Victorian State Trauma Outcome Registry and Monitoring group is thanked for the provision of VSTR data.
Funding Information:
Dr Amy Freeman-Sanderson is on the Editorial Board of Australian Critical Care. This manuscript was managed through the usual editorial processes and independent of Dr Freeman-Sanderson. Professor Carol Hodgson's research is funded by a NHMRC Investigator Grant. No other authors have any reported.
Publisher Copyright:
© 2023 Australian College of Critical Care Nurses Ltd
PY - 2024/11
Y1 - 2024/11
N2 - Background: Patients admitted to the intensive care unit (ICU) following trauma often have multiple injuries, which can lead to disordered swallowing, dysphagia. The prevalence of dysphagia in trauma populations ranges between 4.2% and 86%; however, clinical and associated longitudinal health outcomes and patient-reported quality of life are unknown. Objectives: The objective of this study was to compare hospital and clinical outcomes for older critically ill trauma patients diagnosed with and without dysphagia up to 12 months after hospital admission. Secondary outcomes include characteristics of dysphagia assessment and recovery during indexed hospital admission. Methods: Post hoc analysis of an observational study. All patients were recruited from a tertiary ICU trauma unit, all were aged above 50 years, with an expected ICU length of stay of >24 h. Criteria of dysphagia diagnosis were determined via presence of International Classification of Diseases (ICD-10) code (R13). Hospital, clinical, and health-reported quality-of-life data were collected. Results: Ninety-eight patients were included with 79 (81%) being male, overall median injury severity scale: 21.5 (interquartile range: 14–29); 38 (38.8%) with spinal injury, 37 (37.8%) with multitrauma excluding head injury, and 23 (23.5%) with multitrauma including head injury. Prevalence of dysphagia was 29%, with patients diagnosed with dysphagia more likely to have required invasive mechanical ventilation (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.25–12.78), for an increased duration (OR: 2.6, 95% CI: 0.27–4.92) and required longer ICU admission (OR: 2.98, 95% CI: 0.28–5.69). Recovery of swallow function was protracted beyond the indexed hospital admission, with only 18% of those diagnosed with dysphagia returning to a normal, unrestricted, oral diet by hospital discharge. At 6 and 12 months, functional disabilities were reported across the cohort with no significant differences between groups. Conclusions: In older critically ill trauma patients, dysphagia is common. Use and duration of invasive mechanical ventilation and increased ICU length of stay for survivors were significantly increased for those with dysphagia. Management of swallowing is required across the continuum of care commencing in and beyond ICU to optimise recovery and outcomes.
AB - Background: Patients admitted to the intensive care unit (ICU) following trauma often have multiple injuries, which can lead to disordered swallowing, dysphagia. The prevalence of dysphagia in trauma populations ranges between 4.2% and 86%; however, clinical and associated longitudinal health outcomes and patient-reported quality of life are unknown. Objectives: The objective of this study was to compare hospital and clinical outcomes for older critically ill trauma patients diagnosed with and without dysphagia up to 12 months after hospital admission. Secondary outcomes include characteristics of dysphagia assessment and recovery during indexed hospital admission. Methods: Post hoc analysis of an observational study. All patients were recruited from a tertiary ICU trauma unit, all were aged above 50 years, with an expected ICU length of stay of >24 h. Criteria of dysphagia diagnosis were determined via presence of International Classification of Diseases (ICD-10) code (R13). Hospital, clinical, and health-reported quality-of-life data were collected. Results: Ninety-eight patients were included with 79 (81%) being male, overall median injury severity scale: 21.5 (interquartile range: 14–29); 38 (38.8%) with spinal injury, 37 (37.8%) with multitrauma excluding head injury, and 23 (23.5%) with multitrauma including head injury. Prevalence of dysphagia was 29%, with patients diagnosed with dysphagia more likely to have required invasive mechanical ventilation (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.25–12.78), for an increased duration (OR: 2.6, 95% CI: 0.27–4.92) and required longer ICU admission (OR: 2.98, 95% CI: 0.28–5.69). Recovery of swallow function was protracted beyond the indexed hospital admission, with only 18% of those diagnosed with dysphagia returning to a normal, unrestricted, oral diet by hospital discharge. At 6 and 12 months, functional disabilities were reported across the cohort with no significant differences between groups. Conclusions: In older critically ill trauma patients, dysphagia is common. Use and duration of invasive mechanical ventilation and increased ICU length of stay for survivors were significantly increased for those with dysphagia. Management of swallowing is required across the continuum of care commencing in and beyond ICU to optimise recovery and outcomes.
KW - Critical care
KW - Deglutition disorders
KW - Frailty
KW - Quality of life
KW - Rehabilitation
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85179779914&partnerID=8YFLogxK
U2 - 10.1016/j.aucc.2023.10.005
DO - 10.1016/j.aucc.2023.10.005
M3 - Article
C2 - 38097426
AN - SCOPUS:85179779914
SN - 1036-7314
VL - 37
SP - 957
EP - 963
JO - Australian Critical Care
JF - Australian Critical Care
IS - 6
ER -