Bedside dysphagia screens in patients with traumatic cervical injuries: An ideal tool for an under-recognized problem.

Autor:	Posillico SE; From the Department of Surgery (S.E.P., J.F.G., A.D.R., L.A.K., K.J.C-S., J.A.C.), Speech and Language Pathology Services, Department of Rehabilitation, Physical Therapy, and Occupational Therapy (R.S.W.), and Department of Neurosurgery (M.L.K.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio., Golob JF, Rinker AD, Kreiner LA, West RS, Conrad-Schnetz KJ, Kelly ML, Claridge JA
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2018 Oct; Vol. 85 (4), pp. 697-703.
DOI:	10.1097/TA.0000000000002035
Abstrakt:	Background: We initiated a prospective interventional study using 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 with 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 with a previous 18-month cohort of similar patients. Our new protocol mandated that every patient underwent a BDS before 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 before 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 with 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: Study type diagnostic test, level III.
Databáze:	MEDLINE
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