title: Swallowing dysfunction in trauma patients with cervical spine fractures treated with halo-vest fixation.
abstract: ACKGROUND:: Cervical spine fractures are common in traumatically injured patients. The halo-vest brace is a common treatment used for these fractures. We hypothesize that the use of halo-vest fixation is associated with a high incidence of dysphagia in trauma patients.
  
  
  METHODS
  All trauma patients at our Level I Trauma Center from August 2005 to August 2007 were analyzed retrospectively via the trauma registry (N=3,702). Included were adult patients with cervical spine fractures treated with halo-vests and evaluated formally by speech-language pathologists for dysphagia and aspiration. Patients were categorized into mild, moderate, and severe dysphagia.
  
  
  RESULTS
  Of the 3,702 patients, 369 (10%) had cervical spine fractures from blunt trauma and 56 met inclusion criteria. Of these, 19 (34%) had no evidence of swallowing dysfunction and the remaining 37 (66%) had evidence of dysphagia. Thirteen (23%) exhibited symptoms of aspiration. There were no significant differences in age, gender, Injury Severity Score, arrival Revised Trauma Score, or arrival Glasgow Coma Scale score on presentation. Dysphagia is associated with longer intensive care unit stays (p=0.019) and trends toward a longer hospital stay (p=0.083). In trauma patients with halo-vests, increasing severity of dysphagia from mild to moderate is associated with longer ventilator days (p=0.005), intensive care unit days (p=0.001), and hospital length of stay (p=0.015).
  
  
  CONCLUSIONS
  Patients with cervical fractures treated with halo-vest fixation have a significantly high incidence of dysphagia and aspiration. Dysphagia in trauma patients treated with halo-vests for c-spine fractures is common, associated with worse outcomes, and difficult to predict. Therefore, all of these patients should be formally evaluated for dysphagia.
authors.affiliation: Department of Surgery, University of South Carolina School of Medicine-Palmetto Health, Columbia, South Carolina 29203, USA. bradley.trey@gmail.com
authors.forename: Joel F
authors.initials: JF
authors.lastname: Bradley
authors.forename: Mark A
authors.initials: MA
authors.lastname: Jones
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Farmer
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Fann
authors.forename: Raymond
authors.initials: R
authors.lastname: Bynoe
mesh_terms: D000328:Adult; D001915:Braces; D002574:Cervical Vertebrae / Q000293:injuries*; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology / Q000628:therapy