Predictors of dysphagia after spinal cord injury
Predictors of dysphagia after spinal cord injury
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DOI：
10.1016/s0003-9993(99)90068-0
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发表时间：
1999-09-01
影响因子：
4.3
通讯作者：
Jarosz, P
中科院分区：
文献类型：
--
作者：
Kirshblum, S;Johnston, MV;Jarosz, P
目的：量化吞咽缺陷的发生率（吞咽困难）并确定急性创伤性脊髓损伤后康复环境中吞咽困难风险的预测因素。设计：回顾性病例对照研究。设置：独立康复医院。患者：收集了187例急性创伤性脊髓损伤患者的数据，这些患者在4年内接受了吞咽筛查，其中42名患者接受了电视透视吞咽研究（VFSS）。主要结果：对怀疑有吞咽问题的患者进行VFSS。吞咽困难的可能的前因记录从医疗记录，包括以前的历史，脊柱手术，手术方法和技术，气管切开术和呼吸机的状态，神经损伤的水平，ASIA损伤分类，矫形器，损伤的病因，年龄，和gender.Results：入院康复22.5%（n = 42）的脊髓损伤患者有症状，提示吞咽困难。在73.8%（n = 31）的病例中，检查证实了吞咽困难（误吸或需要调整饮食），而VFSS在26.2%（n = 11）的病例中排除了吞咽困难。Logistic回归和其他分析揭示了吞咽困难风险的三个重要预测因素：年龄（p <0.028），气管切开术和机械通气（p <0.001），以及颈椎前路脊柱手术（p <0.016）。分析的其他变量与吞咽困难没有关系或最多有轻微关系。入院时气管切开术是吞咽困难的最强预测因素。在康复入院和前路手术的方法相结合的气管切开术有极高的吞咽困难率（48%）。结论：吞咽异常是目前在一个显着的比例与急性创伤性颈脊髓损伤的患者提出康复。气管造口术的患者出现吞咽困难的风险明显增加，尽管其他因素也是相关的。应评估吞咽困难的风险，以降低与吞咽异常相关的发病率。(C)1999年由美国康复医学大会和美国物理医学和康复学会。
Objective: To quantify the incidence of swallowing deficits (dysphagia) and to identify factors that predict risk for dysphagia in the rehabilitation setting following acute traumatic spinal cord injury.Design: Retrospective case-control study.Setting: Freestanding rehabilitation hospital.Patients: Data were collected on 187 patients with acute traumatic spinal cord injury admitted for rehabilitation over a 4-year period who underwent a swallowing screen, in which 42 underwent a videofluoroscopic swallowing study (VFSS).Main Outcome Measures: VFSS was performed on patients with suspected swallowing problems. Possible antecedents of dysphagia were recorded from the medical record including previous history of spine surgery, surgical approach and technique, tracheostomy and ventilator status, neurologic level of injury, ASIA Impairment Classification, orthosis, etiology of injury, age, and gender.Results: On admission to rehabilitation 22.5% (n = 42) of spinal cord injury patients had symptoms suggesting dysphagia. In 73.8% (n = 31) of these cases, testing confirmed dysphagia (aspiration or requiring a modified diet), while VFSS ruled out dysphagia in 26.2% (n = 11) cases. Logistic regression and other analyses revealed three significant predictors of risk for dysphagia: age (p < .028), tracheostomy and mechanical ventilation (p < .001), and spinal surgery via an anterior cervical approach (p < .016). Other variables analyzed had no relation or at best a slight relation to dysphagia. Tracheostomy at admission was the strongest predictor of dysphagia. The combination of tracheostomy at rehabilitation admission and anterior surgical approach had an extremely high rate of dysphagia (48%).Conclusion: Swallowing abnormalities are present in a significant percentage of patients presenting to rehabilitation with acute traumatic cervical spinal cord injury. Patients with a tracheostomy appear to have a substantially increased risk of development of dysphagia, although other factors are also relevant. Risk of dysphagia should be evaluated to decrease the potential for morbidity related to swallowing abnormalities. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.