Incidence of Aspiration Post-ABI

Authors/Year/

Country/ Study Design/ N

Methods

Outcomes

Terre & Mearin (2009)
Spain
Longitudinal Follow-up
N=26

 

 

 

Population: TBI; Mean Age=34yr; Gender: Male=20, Female=6; Mean GCS=4; Mean Time Post Injury=3mo.
Treatment: Patients with a videofluoroscopic (VFS) diagnosis of aspiration were assessed for aspiration at 1, 3, 6, and 12 mo.
Outcome Measure: Rancho Los Amigos Level Cognitive Function Scale (RLCF), Disability Rating Scale (DRS), VFS.

  1. At baseline, aspiration occurred prior to swallowing in 15%, during pharyngeal contraction in 73%, and after swallowing in 12%.
  2. At baseline, 35% of patients were silent aspirators. This was resolved in all patients by 3 months.
  3. At 3, 6 and 12 follow-up, the number of patients with aspiration was 14, 8 and 6, respectively.
  4. Patients who showed aspiration at 1 year had a baseline RLFC score of III and DRS score of 20, while patients without aspiration had RLFC >IV and DRS score of 16. A significant relationship was found between the presence of aspiration and RLFC score (p=0.039), and DRS (p=0.003).

O’Neil-Pirozzi et al. (2003)
USA
Observational
N=12

Population: TBI; Mean Age=51.17yr; Gender: Male=11, Female=1; GCS Score<8; Mean Time Post Injury=78.6d.
Treatment: Post hoc analysis of acute rehabilitation patient data. All patients had a Modified Barium Swallow (MBS) study.
Outcome Measure: Presence of aspiration.

  1. 3 (25%) patients aspirated. All three of these patients aspirated silently.
  2. After the MBS study none of the subjects developed aspiration pneumonia or other swallowing complications.

Mackay et al. (1999b)
USA
Observational
N=54

 

Population: Brain injury; Mean Age=26.8yr; Gender: Male=45, Female=9; Mean Time Post Injury=17.6d; Range of GCS Scores=3-8.
Treatment: Patients treated with early rehabilitation intervention (initiated <24 hr of admission) had their swallowing evaluated.
Outcome Measure: Videofluoroscopic Swallow Study (VFSS).

  1. 22(41%) patients aspirated.
  2. Patients with aspiration required ventilation more than twice as long as those without aspiration (16.14d vs. 6.84d, p<0.03).
  3. Those with aspiration also had lower admission GCS scores and RLA scores compared to those without (GCS, 4.45 vs. 5.53; RLA, 2.2 vs. 2.64).
  4. Aspiration occurred most commonly during the swallow (77%), then before (41%) and after (18%) the swallow.

Schurr et al. (1999)
USA
Retrospective Review
N=47

 

 

Population: TBI; Mean Age=37yr; Gender: Male=32, Female=15; Mean GCS Score=8
Treatment: Review of medical records of patients who had a bedside evaluation completed by a certified speech pathologist. Those with abnormal findings were referred for a Videofluoroscopic Swallow Study (VFSS).
Outcome Measure: Incidence of aspiration.

  1. 2 patients had overt aspiration and were not referred for a VFSS test.
  2. 31 patients had a VFSS; 22 (71%) had aspiration. 
  3. 13 patients had either laryngeal penetration or minor aspirations which were responsive to initial positional and dietary modifications and patients could be fed orally.
  4. 5 other patients had silent aspiration that was initially non-responsive to initial therapies, but responsive to later dysphagia therapy and later resumed oral diet.