Incidence of Aspiration and Dysphagia in Geriatric Trauma Patients

BackgroundTrauma is a leading cause of death worldwide. Dysphagia and aspiration are potential sequelae of traumatic brain injury (TBI), yet these conditions are not always readily apparent. Fiberoptic endoscopic evaluation of swallowing (FEES) is a bedside procedure enabling real-time diagnosis of swallowing dysfunction. The aim of this study was to assess the incidence of dysphagia and aspiration in geriatric TBI patients, identify associated risk factors, and ultimately establish specific indications for FEES as a method of formal swallowing evaluation.MethodsA retrospective review was completed on all geriatric (65 or older) trauma patients evaluated in our level I trauma center from July 2021 to July 2023 who had a TBI defined by Abbreviated Injury Scale (AIS) head ≥3. Rates of dysphagia and aspiration were collected in addition to risk factors and associated clinical characteristics. Univariate and multivariable analyses were performed with significance defined by a P-value <0.05.ResultsIn this study (n = 417), 21.8% of participants were found to have dysphagia and 6.9% aspirated. Both dysphagia and aspiration were associated with more hospital and ICU days, lower functional status at discharge (FSD), and lower likelihood of being discharged home. Glasgow Coma Scale (GCS) score less than 15 was an individual predictor of dysphagia as well as mortality.DiscussionBy identifying factors associated with dysphagia and aspiration, we can risk stratify geriatric TBI patients to receive a standardized swallowing evaluation with FEES in an effort to prevent unnecessary morbidity and mortality.