Dysphagia in patients with acute cervical spinal cord injury.
METHODS
Longitudinal observational.


OBJECTIVE
(a) To establish a reliable and feasible method to indicate the presence and severity of dysphagia and (b) to establish a course of treatment in individuals presenting with cervical spinal cord injury (CSCI).


METHODS
Spinal Cord Injury Center, Werner Wicker Klinik, Bad Wildungen, Germany.


METHODS
This is a cross-sectional study of 51 patients consecutively admitted to the Intensive Care Unit of the SCI in-patient service. They were subjected to neurological and fiberoptic endoscopic examination of swallowing (FEES). Data concerning artificial respiration, presence of tracheostomy, oral or non-oral feeding were obtained from the medical charts. Statistics were carried out by a calculation of a nonparametric correlation (Spearman).


RESULTS
Five levels of dysphagia could be distinguished. At levels 1 and 2, patients presented with a severe impairment of swallowing, in level 3 aspiration was met by a powerful coughing reflex, level 4 comprised a laryngeal edema and/or a mild aspiration of fluids only and at level 5 laryngeal function was not compromised. On admission, 20 patients with CSCI presented with mild (level 4), eight with moderate (level 3) and 13 with severe dysphagia (levels 1 and 2). In 10 no signs of dysphagia could be detected. After treatment, level 1 was no longer detected, one patient showed level 2, two patients showed level 3, all other patients showed only mild or no signs of dysphagia any longer.


CONCLUSIONS
Dysphagia of various severities was present in the majority of these patients with CSCI together with respiratory insufficiency. FEES allows for the detection and classification of dysphagia as well as for an evaluation of the therapeutic management. Under interdisciplinary treatment the prognosis of dysphagia is good.
1Spinal Cord Injury Center, Werner Wicker Klinik, Bad Wildungen, Germany.
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C
Wolf
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Meiners
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004185:Disability Evaluation; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000600:supply & distribution