Pneumonia and Dysphagia after Cervical Spine Trauma

Author(s):
Laura Kreiner; Andrew Tran; Christopher Towe; Jeffrey Claridge; Vanessa Ho

Background:

Prior studies demonstrate that patients with cervical spine trauma (CST) have a reported incidence of dysphagia at 17%, and 30% in patients with a cervical spinal cord injury (C-SCI). Dysphagia is a risk factor for pneumonia. It is unknown if dysphagia during the index trauma admission is associated with readmission for pneumonia.

Hypothesis:

We hypothesize that in patients with CST/C-SCI, dysphagia during the index admission (IA) would be associated with an increased rate of readmission for pneumonia.

Methods:

We identified patients who sustained CST/C-SCI in the first 9 months of 2017 from the Nationwide Readmissions Database (NRD). We identified age, sex, injury severity score (ISS), comorbidities, dysphagia at IA, discharge destination, and mortality from IA. We identified all readmissions within 90 days, as well as a diagnosis of pneumonia at readmission. We used logistic regression to identify factors associated with 90-day readmission and pneumonia at readmission. Factors examined included age, injury type (C-CSI vs. no C-CSI), pneumonia or dysphagia at IA, comorbidity count, ISS, IA discharge destination, and payer type.

Results:

We identified 29,644 patients with CST, of whom 7,051 (23.8%) had a C-SCI (median age 64, IQR 46-79; median ISS 14, IQR 10-26). 1,892 (6.4%) died during the index admission. Dysphagia was identified in 8.9%. Among C-SCI patients, dysphagia was identified in 12.8%. Of 27,752 patients who survived the IA, 3,284 (11.8%) were readmitted within 90 days, of whom 461 (14.0%) had a diagnosis of pneumonia. In adjusted logistic regression (Table1), dysphagia was not associated with readmission or pneumonia. Pneumonia at IA was associated with pneumonia at the readmission.

Conclusions:

The incidence of dysphagia during an IA for patients with CST was approximately half of the expected rate. Pneumonia was a common diagnosis during both admissions, and pneumonia at the IA was a strong predictor of pneumonia at readmission. Although dysphagia did not predict readmission, prior studies suggest significant dysphagia was under-diagnosed clinically and therefore is likely under reported in this database.  Protocolized identification of dysphagia in patients with CST and C-SCI may be a key step in minimizing pneumonia related readmission.