BEDSIDE DYSPHAGIA SCREENS IN PATIENTS WITH TRAUMATIC CERVICAL INJURIES: AN IDEAL TOOL FOR AN UNDER-RECOGNIZED PROBLEM

Background We initiated a prospective interventional study utilizing a nurse-driven bedside dysphagia screen (BDS) in patients with cervical spine injury (CI) to address three objectives: 1) determine the incidence of dysphagia; 2) determine the utility of the new BDS as a screening tool; and 3) compare patient outcomes, specifically dysphagia-related complications, in the study period to a retrospective cohort. Methods All patients with CI admitted to a Level I Trauma Center were enrolled in a prospective 12-month study (June 2016-June 2017) and then were compared to a prior 18-month cohort of similar patients. Our new protocol mandated that every patient underwent a BDS prior to oral intake. If the patient failed the BDS, a modified barium swallow (MBS) was obtained. Exclusion criteria were emergency department discharge, inability to participate in a BDS, leaving against medical advice, BDS protocol violations, or death prior to BDS. A failed MBS was defined as a change in diet and a need for a repeat MBS. Dysphagia was defined as a failed MBS or the presence of a dysphagia-related complication. Results Of 221 consecutive prospective patients identified, 114 met inclusion criteria. The incidence of dysphagia was 16.7% in all prospective study patients, 14.9% in patients with isolated CI, and 30.8% in patients with spinal cord injury. The BDS demonstrated 84.2% sensitivity, 95.8% specificity, 80.0% positive predictive value, and 96.8% negative predictive value. There were no dysphagia-related complications. The prospective study patients demonstrated significantly less dysphagia-related complications (p=0.048) when compared to the retrospective cohort of 276 patients. Conclusions The introduction of the BDS resulted in increased dysphagia diagnoses, with a significant reduction in dysphagia-related complications. We recommend incorporating BDS into care pathways for patients with CI. Level of Evidence Level III Study Type Diagnostic Test CORRESPONDENCE: Jeffrey A. Claridge, MD, MS, Professor of Surgery, Case Western Reserve University School of Medicine, Trauma Medical Director, Division Director, Service Line Administrator, Trauma, Critical Care, Burns & Acute Care Surgery, Room H947, Hamann Bldg, 2500 MetroHealth Dr. Cleveland, OH 44109, jclaridge@metrohealth.org, Phone: 216-778-4684, Fax: 216-778-1351 Presentations: - Raymond H. Alexander Resident Paper Competition at the 31st Annual Meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018 in Lake Buena Vista, Florida - 41st Annual Resident Trauma Paper Competition at the 96th Annual Meeting of the National Committee on Trauma, March 7-11, 2018 in San Antonio, Texas. - Annual Resident Trauma Paper Competition at the Annual Meeting of the Region V Committee on Trauma, November 30, 2018, in Madison, WI - Annual Resident Trauma Paper Competition at the Annual Meeting of the Ohio State Committee on Trauma, May 12, 2017, in Cleveland, OH The authors have no conflicts of interest to disclose. There were no external sources of funding for this study. © 2018 Lippincott Williams & Wilkins, Inc.

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