Treffer: Predictors of swallowing outcomes in patients with combat-injury related dysphagia.
Title:
Predictors of swallowing outcomes in patients with combat-injury related dysphagia.
Authors:
Solomon NP; From the Walter Reed National Military Medical Center, (N.P.S., A.M.D., K.D.-B.) Bethesda, MD; University of Nebraska-Lincoln (A.M.D.); SonoSante, LLC (K.D.-B.), Columbia, MD., Dietsch AM, Dietrich-Burns K
Source:
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2020 Aug; Vol. 89 (2S Suppl 2), pp. S192-S199.
Publication Type:
Comparative Study; Journal Article; Observational Study; Research Support, U.S. Gov't, Non-P.H.S.
Language:
English
Journal Info:
Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE
Imprint Name(s):
Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins
MeSH Terms:
Deglutition* , Military Personnel*, Brain Injuries, Traumatic/*complications , Deglutition Disorders/*etiology , Maxillofacial Injuries/*complications , War-Related Injuries/*complications, Adult ; Analysis of Variance ; Bayes Theorem ; Databases, Factual ; Deglutition Disorders/therapy ; Humans ; Middle Aged ; Military Medicine ; Retrospective Studies ; Speech Disorders/etiology ; Speech Disorders/therapy ; Treatment Outcome ; United States ; War-Related Injuries/physiopathology ; Young Adult
References:
Esnault P, Cardinale M, Boret H, et al. Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution. J Neurosurg. 2017;127(1):16–22.
Ragel BT, Klimo P Jr., Martin JE, Teff RJ, Bakken HE, Armonda RA. Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus. 2010;28(5):E2.
Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ. Neurological effects of blast injury. J Trauma. 2010;68(5):1257–1263.
Clark N, Birely B, Manson PN, Slezak S, Kolk CV, Robertson B, Crawley W. High-energy ballistic and avulsive facial injuries: classification, patterns, and an algorithm for primary reconstruction. Plast Reconstr Surg. 1996;98(4):583–601.
Christensen J, Sawatari Y, Peleg M. High-energy traumatic maxillofacial injury. J Craniofac Surg. 2015;26(5):1487–1491.
Telischi FF, Patete ML. Blast injuries to the facial nerve. Otolaryngol Head Neck Surg. 1994;111(4):446–449.
Koren I, Shimonove M, Shvero Y, Feinmesser R. Unusual primary and secondary facial blast injuries. Am J Otolaryngol. 2003;24(1):75–77.
Solomon NP, Dietsch AM, Dietrich-Burns KE, Styrmisdottir EL, Armao CS. Dysphagia management and research in an acute-care military treatment facility: the role of applied informatics. Mil Med. 2016;181(Suppl 5):138–144.
Brard C, Le Teuff G, Le Deley MC, Hampson LV. Bayesian survival analysis in clinical trials: what methods are used in practice? Clin Trials. 2017;14(1):78–87.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–98.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.
ASHA. American Speech-Language-Hearing Association: National Outcomes Measurement System (ASHA NOMS). n.d.
O'Neil ME, Carlson K, Storzbach D, Brenner L, Freeman MP, Quinones A, Motu'apuaka M, Ensley M, Kansagara D. Complications of mild traumatic brain injury in veterans and military personnel: a systematic review [internet]. Washington (DC): Department of Veterans Affairs (US); 2013. Table A-1, Classification of TBI Severity.
Borders JC, Gibson AL, Grayev A, Thibeault S. Predictors of dysphagia in critically injured patients with neck trauma. J Crit Care. 2018;44:312–317.
Eckert MJ, Clagett C, Martin M, Azarow K. Bronchoscopy in the blast injury patient. Arch Surg. 2006;141(8):806–809.
Smith H, Peek-Asa C, Nesheim D, Nish A, Normandin P, Sahr S. Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center. J Trauma Nurs. 2012;19(1):57–65.
Mandaville A, Ray A, Robertson H, Foster C, Jesser C. A retrospective review of swallow dysfunction in patients with severe traumatic brain injury. Dysphagia. 2014;29(3):310–318.
Zor F, Aykan A, Coskun U, Aksu M, Ozturk S. Late oropharyngeal functional outcomes of suicidal maxillofacial gunshot wounds. J Craniofac Surg. 2015;26(3):691–695.
Dietsch AM, Dorris HD, Pearson WG Jr., Dietrich-Burns KE, Solomon NP. Taste manipulation and swallowing mechanics in trauma-related sensory-based dysphagia. J Speech Lang Hear Res. 2019;62(8):2703–2712.
Dietsch AM, Rowley CB, Solomon NP, Pearson WG Jr. Swallowing mechanics associated with artificial airways, bolus properties, and penetration-aspiration status in trauma patients. J Speech Lang Hear Res. 2017;60(9):2442–2451.
Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia. 2010;25(1):35–39.
Ajemian MS, Nirmul GB, Anderson MT, Zirlen DM, Kwasnik EM. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg. 2001;136(4):434–437.
Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998;13(4):208–212.
Leder SB, Warner HL, Suiter DM, et al. Evaluation of swallow function post-extubation: is it necessary to wait 24 hours? Ann Otol Rhinol Laryngol. 2019;128(7):619–624.
Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665–673.
Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231.
Oshodi A, Dysart K, Cook A, Rodriguez E, Zhu Y, Shaffer TH, Miller TL. Airway injury resulting from repeated endotracheal intubation: possible prevention strategies. Pediatr Crit Care Med. 2011;12(1):e34–e39.
Mukdad L, Kashani R, Mantha A, Sareh S, Mendelsohn A, Benharash P. The incidence of dysphagia among patients undergoing TAVR with either general anesthesia or moderate sedation. J Cardiothorac Vasc Anesth. 2019;33(1):45–50.
Cottrell JE, Hartung J. Anesthesia and cognitive outcome in elderly patients: a narrative viewpoint. J Neurosurg Anesthesiol. 2020;32(1):9–17.
Fodale V, Tripodi VF, Penna O, Fama F, Squadrito F, Mondello E, David A. An update on anesthetics and impact on the brain. Expert Opin Drug Saf. 2017;16(9):997–1008.
Leder SB, Suiter DM, Lisitano Warner H. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia. 2009;24(3):290–295.
Pai AB, Jasper NR, Cifu DX. Rehabilitation of injured U.S. service member with traumatic brain injury, stroke, spinal cord injury, and bilateral amputations: a case report. J Rehabil Res Dev. 2012;49(8):1191–1196.
Jha RM, Shutter L. Neurologic complications of polytrauma. Handb Clin Neurol. 2017;141:633–655.
Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: an expert overview. Rev Neurol. 2017;173(7–8):461–472.
Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):1–11.
Ragel BT, Klimo P Jr., Martin JE, Teff RJ, Bakken HE, Armonda RA. Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus. 2010;28(5):E2.
Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ. Neurological effects of blast injury. J Trauma. 2010;68(5):1257–1263.
Clark N, Birely B, Manson PN, Slezak S, Kolk CV, Robertson B, Crawley W. High-energy ballistic and avulsive facial injuries: classification, patterns, and an algorithm for primary reconstruction. Plast Reconstr Surg. 1996;98(4):583–601.
Christensen J, Sawatari Y, Peleg M. High-energy traumatic maxillofacial injury. J Craniofac Surg. 2015;26(5):1487–1491.
Telischi FF, Patete ML. Blast injuries to the facial nerve. Otolaryngol Head Neck Surg. 1994;111(4):446–449.
Koren I, Shimonove M, Shvero Y, Feinmesser R. Unusual primary and secondary facial blast injuries. Am J Otolaryngol. 2003;24(1):75–77.
Solomon NP, Dietsch AM, Dietrich-Burns KE, Styrmisdottir EL, Armao CS. Dysphagia management and research in an acute-care military treatment facility: the role of applied informatics. Mil Med. 2016;181(Suppl 5):138–144.
Brard C, Le Teuff G, Le Deley MC, Hampson LV. Bayesian survival analysis in clinical trials: what methods are used in practice? Clin Trials. 2017;14(1):78–87.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–98.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.
ASHA. American Speech-Language-Hearing Association: National Outcomes Measurement System (ASHA NOMS). n.d.
O'Neil ME, Carlson K, Storzbach D, Brenner L, Freeman MP, Quinones A, Motu'apuaka M, Ensley M, Kansagara D. Complications of mild traumatic brain injury in veterans and military personnel: a systematic review [internet]. Washington (DC): Department of Veterans Affairs (US); 2013. Table A-1, Classification of TBI Severity.
Borders JC, Gibson AL, Grayev A, Thibeault S. Predictors of dysphagia in critically injured patients with neck trauma. J Crit Care. 2018;44:312–317.
Eckert MJ, Clagett C, Martin M, Azarow K. Bronchoscopy in the blast injury patient. Arch Surg. 2006;141(8):806–809.
Smith H, Peek-Asa C, Nesheim D, Nish A, Normandin P, Sahr S. Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center. J Trauma Nurs. 2012;19(1):57–65.
Mandaville A, Ray A, Robertson H, Foster C, Jesser C. A retrospective review of swallow dysfunction in patients with severe traumatic brain injury. Dysphagia. 2014;29(3):310–318.
Zor F, Aykan A, Coskun U, Aksu M, Ozturk S. Late oropharyngeal functional outcomes of suicidal maxillofacial gunshot wounds. J Craniofac Surg. 2015;26(3):691–695.
Dietsch AM, Dorris HD, Pearson WG Jr., Dietrich-Burns KE, Solomon NP. Taste manipulation and swallowing mechanics in trauma-related sensory-based dysphagia. J Speech Lang Hear Res. 2019;62(8):2703–2712.
Dietsch AM, Rowley CB, Solomon NP, Pearson WG Jr. Swallowing mechanics associated with artificial airways, bolus properties, and penetration-aspiration status in trauma patients. J Speech Lang Hear Res. 2017;60(9):2442–2451.
Leder SB, Ross DA. Confirmation of no causal relationship between tracheotomy and aspiration status: a direct replication study. Dysphagia. 2010;25(1):35–39.
Ajemian MS, Nirmul GB, Anderson MT, Zirlen DM, Kwasnik EM. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg. 2001;136(4):434–437.
Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998;13(4):208–212.
Leder SB, Warner HL, Suiter DM, et al. Evaluation of swallow function post-extubation: is it necessary to wait 24 hours? Ann Otol Rhinol Laryngol. 2019;128(7):619–624.
Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665–673.
Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231.
Oshodi A, Dysart K, Cook A, Rodriguez E, Zhu Y, Shaffer TH, Miller TL. Airway injury resulting from repeated endotracheal intubation: possible prevention strategies. Pediatr Crit Care Med. 2011;12(1):e34–e39.
Mukdad L, Kashani R, Mantha A, Sareh S, Mendelsohn A, Benharash P. The incidence of dysphagia among patients undergoing TAVR with either general anesthesia or moderate sedation. J Cardiothorac Vasc Anesth. 2019;33(1):45–50.
Cottrell JE, Hartung J. Anesthesia and cognitive outcome in elderly patients: a narrative viewpoint. J Neurosurg Anesthesiol. 2020;32(1):9–17.
Fodale V, Tripodi VF, Penna O, Fama F, Squadrito F, Mondello E, David A. An update on anesthetics and impact on the brain. Expert Opin Drug Saf. 2017;16(9):997–1008.
Leder SB, Suiter DM, Lisitano Warner H. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia. 2009;24(3):290–295.
Pai AB, Jasper NR, Cifu DX. Rehabilitation of injured U.S. service member with traumatic brain injury, stroke, spinal cord injury, and bilateral amputations: a case report. J Rehabil Res Dev. 2012;49(8):1191–1196.
Jha RM, Shutter L. Neurologic complications of polytrauma. Handb Clin Neurol. 2017;141:633–655.
Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: an expert overview. Rev Neurol. 2017;173(7–8):461–472.
Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):1–11.
Entry Date(s):
Date Created: 20200219 Date Completed: 20210104 Latest Revision: 20210210
Update Code:
20250114
DOI:
10.1097/TA.0000000000002623
PMID:
32068719
Database:
MEDLINE
Weitere Informationen
Background: Traumatic injuries, such as those from combat-related activities, can lead to complicated clinical presentations that may include dysphagia.
Methods: This retrospective observational database study captured dysphagia-related information for 215 US military service members admitted to the first stateside military treatment facility after sustaining combat-related or combat-like traumatic injuries. A multidimensional relational database was developed to document the nature, course, and management for dysphagia in this unique population and to explore variables predictive of swallowing recovery using Bayesian statistical modeling and inferential statistical methods.
Results: Bayesian statistical modeling revealed the importance of maxillofacial fractures and soft tissue loss as primary predictors of poor swallowing outcomes. The presence of traumatic brain injury (TBI), though common, did not further complicate dysphagia outcomes. A more detailed examination and rating of videofluoroscopic swallow studies from a subset of 161 participants supported greater impairment for participants with maxillofacial trauma and no apparent relationship between having sustained a TBI and swallow functioning.
Conclusion: These analyses revealed that maxillofacial trauma is a stronger indicator than TBI of dysphagia severity and slower or incomplete recovery following combat-related injuries.
Level of Evidence: Therapeutic/Care Management study, level IV.