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Survival estimates for patients with abnormal swallowing studies
M E Cowen1, S L Simpson, T E Vettese
1St. Joseph Mercy Hospital, Ann Arbor, Mich 48106, USA.
Objective:
To better understand the life expectancy of patients who have an abnormal videofluoroscopic swallowing study.
Design:
Retrospective cohort study. The common starting point was the time of the severely abnormal swallowing study. Hospital charts were reviewed for clinical variables of potential prognostic significance by reviewers blinded to the outcome of interest, survival time.
Setting:
A university-affiliated, community teaching hospital.
Patients:
One hundred forty-nine hospitalized patients who were deemed nonoral feeders based on their swallowing study. Patients excluded were those with head, neck, or esophageal cancer, or those undergoing a thoracotomy procedure.
Measurements And Main Results:
Clinical and demographic variables and time until death or censoring were measured. Overall 1-year mortality was 62%. Multivariable Cox proportional hazards analyses identified four variables that independently predicted death: advanced age, reduced serum albumin concentration, disorientation to person, and higher Charlson comorbidity score. Eighty patients (54%) subsequently underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube after their swallowing study.
Conclusions:
Mortality is high in patients with severely abnormal swallowing studies. Common clinical variables can be used to identify groups of patients with particularly poor prognoses. This information may help guide discussions regarding possible PEG placement.