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Severe dysphagia requiring gastrostomy following cervical spine fracture fixation

BACKGROUND: The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve qu...

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Autores principales: Bailey, Joanelle A, Lavery, Robert F, Adams, John M, Livingston, Andrew S, DiFazio, Lou, Livingston, David H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891693/
https://www.ncbi.nlm.nih.gov/pubmed/29766050
http://dx.doi.org/10.1136/tsaco-2016-000001
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author Bailey, Joanelle A
Lavery, Robert F
Adams, John M
Livingston, Andrew S
DiFazio, Lou
Livingston, David H
author_facet Bailey, Joanelle A
Lavery, Robert F
Adams, John M
Livingston, Andrew S
DiFazio, Lou
Livingston, David H
author_sort Bailey, Joanelle A
collection PubMed
description BACKGROUND: The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve quickly. We hypothesized that patient and clinical factors could be used to predict severe dysphagia requiring GT placement in this population. METHODS: A retrospective multicenter review of all adult patients requiring operative fixation of cervical spine fractures was performed. Data on demographics, injury severity score, presence of spinal cord injury, operative approach, presence of severe traumatic brain injury, and the need and timing of tracheostomy and GT were collected. The timing, number and results of formal speech, and language pathology examinations were also recorded. RESULTS: 243 patients underwent cervical spine fixation for traumatic fractures, of which 72 (30%) required GT placement. Patients requiring gastrostomy were significantly older, 54 versus 45 years (p=0.002), and had higher injury severity scores at 24 versus 18 (p<0.0001). Tracheostomy was strongly associated with severe dysphagia; GT was required in 83% of patients who underwent tracheostomy versus 5% of those who did not require tracheostomy. 50% of patients underwent tracheostomy and GT on the same day after injury, with the remaining patients having an average of 9 days delay between procedures. The need for gastrostomy placement was also higher in patients undergoing combined operative approach versus anterior or posterior approach alone (p=0.02). There were no GT-related complications. CONCLUSIONS: Severe dysphagia requiring GT placement occurs commonly (30%) in patients who undergo operative fixation of cervical spine fractures. Gastrostomy placement was delayed in 50%. Tracheostomy was strongly associated with the need for GT placement. Earlier GT placement, especially in patients requiring tracheostomy, would improve patient care and disposition.
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spelling pubmed-58916932018-05-14 Severe dysphagia requiring gastrostomy following cervical spine fracture fixation Bailey, Joanelle A Lavery, Robert F Adams, John M Livingston, Andrew S DiFazio, Lou Livingston, David H Trauma Surg Acute Care Open Original Article BACKGROUND: The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve quickly. We hypothesized that patient and clinical factors could be used to predict severe dysphagia requiring GT placement in this population. METHODS: A retrospective multicenter review of all adult patients requiring operative fixation of cervical spine fractures was performed. Data on demographics, injury severity score, presence of spinal cord injury, operative approach, presence of severe traumatic brain injury, and the need and timing of tracheostomy and GT were collected. The timing, number and results of formal speech, and language pathology examinations were also recorded. RESULTS: 243 patients underwent cervical spine fixation for traumatic fractures, of which 72 (30%) required GT placement. Patients requiring gastrostomy were significantly older, 54 versus 45 years (p=0.002), and had higher injury severity scores at 24 versus 18 (p<0.0001). Tracheostomy was strongly associated with severe dysphagia; GT was required in 83% of patients who underwent tracheostomy versus 5% of those who did not require tracheostomy. 50% of patients underwent tracheostomy and GT on the same day after injury, with the remaining patients having an average of 9 days delay between procedures. The need for gastrostomy placement was also higher in patients undergoing combined operative approach versus anterior or posterior approach alone (p=0.02). There were no GT-related complications. CONCLUSIONS: Severe dysphagia requiring GT placement occurs commonly (30%) in patients who undergo operative fixation of cervical spine fractures. Gastrostomy placement was delayed in 50%. Tracheostomy was strongly associated with the need for GT placement. Earlier GT placement, especially in patients requiring tracheostomy, would improve patient care and disposition. BMJ Publishing Group 2016-06-08 /pmc/articles/PMC5891693/ /pubmed/29766050 http://dx.doi.org/10.1136/tsaco-2016-000001 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Original Article
Bailey, Joanelle A
Lavery, Robert F
Adams, John M
Livingston, Andrew S
DiFazio, Lou
Livingston, David H
Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title_full Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title_fullStr Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title_full_unstemmed Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title_short Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
title_sort severe dysphagia requiring gastrostomy following cervical spine fracture fixation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891693/
https://www.ncbi.nlm.nih.gov/pubmed/29766050
http://dx.doi.org/10.1136/tsaco-2016-000001
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