Dysphagia is associated with worse clinical outcomes in geriatric trauma patients
Introduction Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcom...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e001043.full |
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| author | Lillian S Kao John A Harvin Charles E Wade Claudia Pedroza David E Meyer Shah-Jahan M Dodwad Heather R Kregel Mina Attia Michael W Wandling Thaddeus J Puzio |
| author_facet | Lillian S Kao John A Harvin Charles E Wade Claudia Pedroza David E Meyer Shah-Jahan M Dodwad Heather R Kregel Mina Attia Michael W Wandling Thaddeus J Puzio |
| author_sort | Lillian S Kao |
| collection | DOAJ |
| description | Introduction Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.Methods Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, Injury Severity Score, mechanism of injury, and gender were performed to determine the association between dysphagia and clinical outcomes.Results Of 1706 geriatric patients, 69 patients (4%) were diagnosed with dysphagia. Patients with dysphagia were older with a higher Injury Severity Score. Increased odds of mortality did not reach statistical significance (OR 1.6, 95% CI 0.6 to 3.4, p=0.30). Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p≤0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p≤0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p≤0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p≤0.001). On Bayesian analysis, dysphagia was associated with an increased probability of longer hospital and ICU LOS, unplanned ICU admission, and non-home discharge.Conclusions Clinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. This study highlights the importance of screening protocols for dysphagia in geriatric trauma patients to possibly mitigate adverse outcomes.Level of evidence Level III. |
| format | Article |
| id | doaj-art-34b7f626271f43d4a5aa341dc050a040 |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-34b7f626271f43d4a5aa341dc050a0402025-08-20T02:07:13ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2022-001043Dysphagia is associated with worse clinical outcomes in geriatric trauma patientsLillian S Kao0John A Harvin1Charles E Wade2Claudia Pedroza3David E Meyer4Shah-Jahan M Dodwad5Heather R Kregel6Mina Attia7Michael W Wandling8Thaddeus J Puzio9Department of Surgery, McGovern Medical School at UT Health Houston, Houston, Texas, USASurgery, University of Texas McGovern Medical School, Houston, Texas, USASurgery, University of Texas McGovern Medical School, Houston, Texas, USADepartment of Pediatrics, McGovern Medical School at UT Health Houston, Houston, Texas, USADepartment of Surgery, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USADepartment of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USADepartment of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USADepartment of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USADepartment of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USADivision of Trauma and Surgical Critical Care, The University of Texas Health Science Center at Houston, Houston, Texas, USAIntroduction Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia.Methods Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, Injury Severity Score, mechanism of injury, and gender were performed to determine the association between dysphagia and clinical outcomes.Results Of 1706 geriatric patients, 69 patients (4%) were diagnosed with dysphagia. Patients with dysphagia were older with a higher Injury Severity Score. Increased odds of mortality did not reach statistical significance (OR 1.6, 95% CI 0.6 to 3.4, p=0.30). Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p≤0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p≤0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p≤0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p≤0.001). On Bayesian analysis, dysphagia was associated with an increased probability of longer hospital and ICU LOS, unplanned ICU admission, and non-home discharge.Conclusions Clinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. This study highlights the importance of screening protocols for dysphagia in geriatric trauma patients to possibly mitigate adverse outcomes.Level of evidence Level III.https://tsaco.bmj.com/content/7/1/e001043.full |
| spellingShingle | Lillian S Kao John A Harvin Charles E Wade Claudia Pedroza David E Meyer Shah-Jahan M Dodwad Heather R Kregel Mina Attia Michael W Wandling Thaddeus J Puzio Dysphagia is associated with worse clinical outcomes in geriatric trauma patients Trauma Surgery & Acute Care Open |
| title | Dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| title_full | Dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| title_fullStr | Dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| title_full_unstemmed | Dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| title_short | Dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| title_sort | dysphagia is associated with worse clinical outcomes in geriatric trauma patients |
| url | https://tsaco.bmj.com/content/7/1/e001043.full |
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