Prospective evaluation of oro-pharyngeal dysphagia after severe traumatic brain injury.
OBJECTIVE
To evaluate clinical, videofluoroscopic findings and clinical evolution of neurogenic dysphagia and to establish the prognostic factors.


METHODS
Prospective cohort study.


METHODS
Forty-eight patients with severe traumatic brain injury (TBI) and clinically-suspected oro-pharyngeal dysphagia were studied. Clinical evaluation of oro-pharyngeal dysphagia and videofluoroscopic examination were performed. Clinical evolution was based on feeding mode at discharge, the presence of respiratory complications and body mass index (BMI) at admission and at discharge.


RESULTS
Sixty-five per cent of patients had impaired gag reflex and 44% cough during oral feeding. Videofluoroscopy revealed some type of disorder in 90% of cases: 65% in the oral phase and 73% in the pharyngeal phase (aspiration in 62.5%, being silent in 41%). At discharge, 45% were on normal diet, 27% on a modified oral diet, 14% combined oral intake and gastrostomy feeding and 14% were fed exclusively by gastrostomy. Feeding mode at discharge substantially correlated with RLCF score at admission (p=0.04) and with RLCF (p=0.009) and DRS (p=0.02) scores at discharge.


CONCLUSIONS
Aspiration is very frequent in patients with severe TBI, being silent in almost half. Cognitive function evaluated with the RLCF is the best prognostic factor. At discharge, 72% of the patients were on oral food intake despite having severe TBI.
Terré
Rosa
R
Unit of Functional Digestive Rehabilitation, Institut Guttmann, Badalona, Spain. rterre@guttmann.com
Mearin
Fermín
F
D015992:Body Mass Index; D001930:Brain Injuries / Q000150:complications*; D015331:Cohort Studies; D003371:Cough; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005471:Fluoroscopy / Q000379:methods; D005683:Gagging; D006801:Humans; D011446:Prospective Studies; D014741:Video Recording