title: Dysphagia Management and Research in an Acute-Care Military Treatment Facility: The Role of Applied Informatics.
abstract: This report describes the development and preliminary analysis of a database for traumatically injured military service members with dysphagia.
  
  
  
  A multidimensional database was developed to capture clinical variables related to swallowing. Data were derived from clinical records and instrumental swallow studies, and ranged from demographics, injury characteristics, swallowing biomechanics, medications, and standardized tools (e.g., Glasgow Coma Scale, Penetration-Aspiration Scale). Bayesian Belief Network modeling was used to analyze the data at intermediate points, guide data collection, and predict outcomes. Predictive models were validated with independent data via receiver operating characteristic curves.
  
  
  
  The first iteration of the model (n = 48) revealed variables that could be collapsed for the second model (n = 96). The ability to predict recovery from dysphagia improved from the second to third models (area under the curve = 0.68 to 0.86). The third model, based on 161 cases, revealed "initial diet restrictions" as first-degree, and "Glasgow Coma Scale, intubation history, and diet change" as second-degree associates for diet restrictions at discharge.
  
  
  
  This project demonstrates the potential for bioinformatics to advance understanding of dysphagia. This database in concert with Bayesian Belief Network modeling makes it possible to explore predictive relationships between injuries and swallowing function, individual variability in recovery, and appropriate treatment options.
authors.affiliation: National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, 4954 North Palmer Road, Building 19, Bethesda, MD 20889.
authors.forename: Nancy Pearl
authors.initials: NP
authors.lastname: Solomon
authors.affiliation: National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, 4954 North Palmer Road, Building 19, Bethesda, MD 20889.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Dietsch
authors.affiliation: National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, 4954 North Palmer Road, Building 19, Bethesda, MD 20889.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Dietrich-Burns
authors.affiliation: DecisionQ Corporation, 1010 Wisconsin Avenue, Northwest, Washington, DC 20007.
authors.forename: Edda L
authors.initials: EL
authors.lastname: Styrmisdottir
authors.affiliation: DecisionQ Corporation, 1010 Wisconsin Avenue, Northwest, Washington, DC 20007.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Armao
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D003680:Deglutition Disorders / Q000628:therapy*; D004035:Diet Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale / Q000639:trends; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D000069550:Machine Learning; D008297:Male; D008490:Medical Informatics / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies