Swallowing dysfunction in elderly trauma patients.

PURPOSE: Newly diagnosed swallowing dysfunction is rare, with an incidence <1% in hospitalized patients. The purpose of this study was to evaluate the incidence and clinical characteristics of dysphagia in elderly trauma patients specifically.

METHODS: Patients ≥75years who had newly diagnosed swallowing dysfunction were identified by retrospective review of our institutional trauma database from 2009-2012. A comparison group without dysphagia was also identified that was matched by age, gender, injury mechanism, and injury severity score (ISS). Relevant demographics, injury characteristics, and potential factors associated with dysphagia were collected.

RESULTS: 1323 patients met criteria. Of these, 56(4.2%) had newly identified dysphagia. Cases and controls were similar in regards to regional injury pattern (AIS). Patients with dysphagia had a mean Charlson Comorbidity Index (CCI) of 3.7 vs. 1.9 for patients without dysphagia (p<0.01). Patients with dysphagia also had longer hospital (11.4 vs. 5.8days, p<0.01) and ICU LOS (5.6 vs 1.9days, p<0.01). On multivariable regression, CCI greater than 3 (OR 7.2, p<0.001), in-hospital complications (OR 9.6, p<0.01), and ICU LOS greater than 2days (OR 1.5, p<0.05) were independently associated with the diagnosis of dysphagia.

CONCLUSIONS: Elderly trauma patients with a high comorbidity burden or with prolonged ICU lengths of stay should be screened for dysphagia.