title: Dysphagia in individuals with tetraplegia: incidence and risk factors.
abstract: OBJECTIVE
  Dysphagia following cervical spinal cord injury (SCI) can increase risk for pulmonary complications that may delay the rehabilitative process. The objective of this study was to identify risk factors for dysphagia after cervical SCI.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Individuals with cervical SCI within 31 days of injury underwent a bedside swallow evaluation (BSE) followed by a videofluoroscopy swallow study (VFSS) within 72 hours of the BSE. Subjects were diagnosed as having dysphagia if they had positive findings in either BSE or VFSS.
  
  
  RESULTS
  Twenty-nine patients (7 female and 22 male) were enrolled. Of these, 21 (72%) had high cervical tetraplegia (C4 or higher) and 8 (38%) had lower cervical tetraplegia. A tracheostomy was present in 18 (62%) patients; 15 (52%) subjects were on ventilators. Dysphagia was diagnosed in 12 (41%) subjects. Dysphagia was noted in 62% of the subjects with tracheostomy and 53% of the subjects on the ventilator, but only tracheostomy resulted in a statistically significant association with dysphagia (P = 0.047). All three subjects who had nasogastric tubes were diagnosed with dysphagia (P = 0.029). The relationships between dysphagia and gender, high versus low tetraplegia, presence of halo or collar, head injury, and ventilator use were not statistically significant, but age was a significant risk factor (P = 0.028).
  
  
  CONCLUSIONS
  Dysphagia is present in about 41% of individuals with acute tetraplegia. Only age, tracheostomy, and nasogastric tubes were identified as significant risk factors for dysphagia for individuals with tetraplegia. No relationship between dysphagia and level of SCI, spine surgery, collar, and ventilator use was found to exist.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95128, USA. kazuko.shem@hhs.sccgov.org
authors.forename: Kazuko
authors.initials: K
authors.lastname: Shem
authors.forename: Kathleen
authors.initials: K
authors.lastname: Castillo
authors.forename: Sandra
authors.initials: S
authors.lastname: Wong
authors.forename: James
authors.initials: J
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D011446:Prospective Studies; D011782:Quadriplegia / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014139:Tracheostomy / Q000706:statistics & numerical data