Dysphagia in the burn patient: Experience in a National Burn Reference Centre

Pavez, Axel; Martínez, María E.

doi:10.1016/j.burns.2019.01.002

Cited by 7 publications

(3 citation statements)

References 41 publications

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“…In the most recent publications burn patients received tracheostomy in 4.3-23% of cases [6][7][8][19][20][21][22][23][24][25]. Our study provides data of clinical outcome and complications of 134 (30.9%) tracheotomized burn patients and therefore represents, to our knowledge, one of the largest single center experiences.…”

Section: Discussionmentioning

confidence: 71%

“…[5]. In non-tracheotomized burn patients, length of orotracheal intubation significantly affects occurrence of dysphagia [6] and therefore, indication and timing for tracheostomy have been discussed extensively in recent literature [7][8][9]. Although favorable effects of early tracheostomy in severely burned patients were reported, studies still failed to demonstrate beneficial effects of early tracheostomy on inpatient mortality, length of inpatient stay or overall survival [7,8].…”

Section: Introductionmentioning

confidence: 99%

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A new nomogram to predict the need for tracheostomy in burned patients

Janik

Grasl

Yıldız

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To evaluate the impact of tracheostomy on complications, dysphagia and outcome in second and third degree burned patients. Methods Inpatient mortality, dysphagia, severity of burn injury (ABSI, TBSA) and complications in tracheotomized burn patients were compared to (I) non-tracheotomized burn patients and (II) matched tracheotomized non-burn patients. Results 134 (30.9%) out of 433 patients who underwent tracheostomy, had a significantly higher percentage of inhalation injury (26.1% vs. 7.0%; p < 0.001), higher ABSI (8.9 ± 2.1 vs. 6.0 ± 2.7; p < 0.001) and TBSA score (41.4 ± 19.7% vs. 18.6 ± 18.8%; p < 0.001) compared to 299 non-tracheotomized burn patients. However, complications occurred equally in tracheotomized burn patients and matched controls and tracheostomy was neither linked to dysphagia nor to inpatient mortality at multivariate analysis. In particular, dysphagia occurred in 6.2% of cases and was significantly linked to length of ICU stay (OR 6.2; p = 0.021), preexisting neurocognitive impairments (OR 5.2; p = 0.001) and patients’ age (OR 3.4; p = 0.046). A nomogram was calculated based on age, TBSA and inhalation injury predicting the need for a tracheostomy in severely burned patients. Conclusion Using the new nomogram we were able to predict with significantly higher accuracy the need for tracheostomy in severely burned patients. Moreover, tracheostomy is safe and is not associated with higher incidenc of complications, dysphagia or worse outcome.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

A new nomogram to predict the need for tracheostomy in burned patients

Janik

Grasl

Yıldız

et al. 2020

Eur Arch Otorhinolaryngol

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“…Burn injuries, which were among the top five medical conditions seen by SLTs in this study, are associated with orofacial and inhalation burns, the presence of artificial airway devices and prolonged mechanical ventilation, all of which may contribute to dysphagia and voice pathologies (Pavez & Martínez, 2019). For patients with acute burn injuries, SLTs are responsible for the prevention of orofacial contractures, tracheostomy management and management of dysphagia and communication disorders; however, SLTs are not yet widely accepted as a core part of the interdisciplinary team working in this context (Pavez & Martínez, 2019). This study advocates for training on the SLT, speech-language therapy.…”

Section: Discussionmentioning

confidence: 94%

A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa

Stone

Hoosen

Hochfelden

et al. 2020

South African Journal of Communication Disorders

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Background The quadruple burden of disease (BoD) and multimorbidity reflected in South Africa’s public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs. Objectives This study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa’s BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital. Method A retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics. Results Non-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were < 56 years ( n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity ( r s = 0.4200; p = 0.0000), but not BoD comorbidity ( r s = 0.0049; p = 0.8058). Conclusion Speech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

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