Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury

Publication date: Available online 30 June 2017
Source:The Spine Journal
Author(s): Tiina Ihalainen, Irina Rinta-Kiikka, Teemu M. Luoto, Tuomo Thesleff, Mika Helminen, Anna-Maija Korpijaakko-Huuhka, Antti Ronkainen
Background ContextLaryngeal penetration-aspiration, entry of material into the airways, is considered the most severe subtype of dysphagia and common among patients with acute cervical spinal cord injury.PurposeThe aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI).Study designA prospective cohort study.Patient sampleThirty-seven patients with TCSCI.Outcome measuresThe highest Rosenbek's penetration-aspiration scale (PAS; range 1-8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics and clinical signs observed during a clinical swallowing trial.MethodsA clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed to all patients within 28 days post-injury. For group comparisons, the patients were divided into two groups: (i) penetrator/aspirators (PAS score ≥3) and (ii) non-penetrator/aspirators (PAS score ≤2). This study was self-funded with no conflict of interest.ResultsOf the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) due to a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator/aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were: (i) necessity of bronchoscopies, (ii) lower level of anterior cervical operation, (iii) coughing, throat clearing, choking related to swallowing, and (iv) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration.ConclusionsThe necessity of bronchoscopies, post-injury lower cervical spine anterior surgery, coughing, throat clearing, choking and changes in voice quality related to swallowing were marked risk factors for aspiration and penetration following a cervical spinal cord injury. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration.



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