Table 1.
Summary table of studies reporting dysphagia following cSCI
| Authors | Study site, period of assessment, inclusion | Study size (n) | Etiology | Mean age (range); M:F | Screen and assessment tools | Dysphagia incidence (%) | Correlating factors | Recommendations |
|---|---|---|---|---|---|---|---|---|
|
Kirshblum et al.1999 (R) [11] |
on admission to rehabilitation unit; Acute traumatic SCI | 187 | Trauma |
44.3 (15–86) 5:1 |
BSE, MBT, VFSS |
22.50% | Age, tracheostomy, ventilation, anterior cervical surgery | Early diagnosis |
|
Wolf & Meiners 2003 (P) [26] |
within 3 months of admission to spinal unit; Acute cervical lesion | 51 |
Trauma 46 Non-trauma 5 |
43.4 (16–89) 2.2:1 |
FEES | 80% | Brainstem lesions, NOT age or level, anterior surgery | Early treatment |
|
Brady et al. 2004 (R) [27] |
on admission to two rehabilitation units; All cervical injuries | 131 | Trauma and non-trauma |
55.6 (17–87) 1:1.2 |
BSE, VFSS/FEES | 55% | Tracheostomy, cervical spinal surgery, brain injury | Identify dysphagia using predictive factors |
|
Abel et al.2004 (P) [28] |
on admission to spinal unit; cSCI | 73 |
Trauma 56 Non-trauma 17 |
42.9(0.57–86.8) 2.3:1 |
Questionnaire, MBT, VFSS | 44% | High cervical and complete injuries, tracheostomy | Early detection and monitoring |
|
Seidl et al. 2010 (R) [29] |
Within 8 weeks of admission to trauma center; C0-C8 | 175 |
Trauma 147 Non-trauma 28 |
43.45 (14–89) 4.6:1 |
BSE + FNE | 16% | Level of paralysis, tracheostomy, ventilation, other injuries | SLP assessment pre-oral feeding, FNE if dysphagia is suspected |
|
Shin et al. 2011 (R) [10] |
Inpatients admitted to spinal unit; All tetraplegic patients | 121 |
Trauma 118 Non-trauma 3 |
44.93 (9–78) 6.6:1 |
VFSS | 8% | Age, tracheostomy, dysphagia signs | Monitor for signs of aspiration |
| Shem et al. 2011 (P) [30] | Acute cSCI within 31 days of injury | 29 | Trauma |
41 3.1:1 |
BSE and VFSS | 41% |
Age, tracheostomy NG tube |
Early screening |
|
Chaw et al. 2012 (P) [31] |
Within 32 days of admission to spinal unit; Acute cSCI | 68 | Trauma and non-trauma |
43 (range not given) 5:1 |
BSE and VFSS within 72 h | 30.90% | Ventilation, tracheostomy, NG, age | Need good pulmonary management |
| Shem et al. 2012 (P) [32] | All admissions to spinal unit; Acute tetraplegia | 40 | Trauma |
41 (23.5–68.7) 3.4:1 |
BSE and VFSS | 40% based on BSE; 44% on VFSS, 14.8% with aspiration | Age, tracheostomy, ventilation, and NG tube | Early screening of all tetraplegic patients |
|
Lee et al. 2016 (R) [22] |
All cSCI admissions to trauma center | 56 | Trauma | Not available | Bedside nurse screen and SLP assessment (decannulated) |
41% (56 patients has cSCI of which 23 had dysphagia) |
Age, spinal cord injury | Elderly and cervical injury should be monitored for risk of dysphagia |
| Hayashi et al. 2017 (R) [14] | Traumatic cSCI admission to spinal injuries center within 3 days | 298 | Trauma |
64 (14–91) 6.1:1 |
Based on tube dependence due to aspiration | 7.0% | Age, severe paralysis, tracheostomy | Evaluate risk factors to identify dysphagia |
| Ihalainen et al. 2017 (P) [33] | Acute cSCI admitted to hospital | 46 | Trauma |
62.1 5.5:1 |
VFSS |
41% penetrated 33% aspirated of which 73% silent aspiration |
VFSS recommended Swallow evaluated by speech and language therapist |
|
| Ihalainen et al. 2018 (P) [34] | cSCI admitted to hospital | 37 | Trauma |
61.2 5.2:1 |
Clinical swallowing trial and VFSS on all patients at 28 days | 51.4% penetrators-aspirators; 71.4% silent aspiration | Need for bronchoscopy, lower level ACSS, coughing, throat clearing, choking, voice quality changes | Use risk factors to initiate preventative measures |
| Shem et al. 2019 (P) [15] | Adult patients admitted to SCI inpatient rehabilitation unit | 76 | Trauma | 48 ± 19 | BSE and VFSS | 30% based on BSE; VFSS (n = 17) 0f which 82% dysphagia, aspiration 21.4% | Tracheostomy, invasive mechanical ventilation, nasogastric tube, history of pneumonia, and older age | Early screening in acute cSCI |
| Hayashi et al. 2020 (P) [35] | Traumatic cSCI admission to spinal injuries center within 2 weeks of injury | 136 | Trauma | 65.1 ± 14.1 years | Dysphagia Severity Scale, width of retropharyngeal space | 32% |
Age, ASIA motor score, tracheostomy, and swelling of retropharyngeal space |
Morphological changes to pharynx affect dysphagia |
| Hayashi et al. 2020 (P) [36] | Traumatic cSCI admission to spinal injuries center within 2 weeks of injury | 65 | Trauma |
67 (60–73 IQR) 14:51 |
Dysphagia severity scale (DSS) and functional oral intake scale (FOIS), supported by FEES and VFSS | 35% reducing to 17% at 3 months | Severity of motor score | Monitor CSCI patients in 2 weeks after injury and those with low motor scores |
R retrospective, P prospective, MBT modified blue-dye test, VFSSS videofluoroscopic swallow study, FEES flexible endoscopic evaluation of swallowing, BSE bedside swallow evaluation, FNE flexible nasendoscopic evaluation