Incidence of Aspiration Post-ABI


Country/ Study Design/ N



Terre & Mearin (2009)
Longitudinal Follow-up




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)

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)


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)
Retrospective Review



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.