Study design: Retrospective study.
Objectives: Swallowing disorder in patients with tetraplegia represents a problem. Incidence and clinical data were examined to determine the influencing factors.
Setting: Level I trauma Center, Berlin, Germany.
Method: Retrospective study (1 September 1997-31 December 2002) on hospitalized patients with acute tetraplegia. The patients' swallowing ability was examined both clinically and endoscopically, and the results correlated with clinical data.
Results: A total of 175 patients (144 (82.29%) male patients and 31 (17.71%) female patients (4.6:1) were studied. The peak age groups (43.45, +/-18.98, 14-89 years) were 20-30 years and over 60 years. C4-C6 were most commonly affected. Tetraplegia was trauma-related in 147 (84%) patients. Twenty-eight (16.0%) patients appeared to be suffering from a swallowing disorder on first feeding, 23 (82.14%) patients with dysphagia were tracheotomized. The level of tetraplegia (chi (2)=19.8; P<0.05), tracheotomy (chi (2)=21.7; P<0.05) and the duration of ventilation (chi (2)=24.84, P<0.05) were all found to be statistically significant factors in the development of a swallowing disorder. Age, surgical approach, level of tetraplegia, severity of paralysis and the need for tracheotomy were predictive of dysphagia in 73.14% patients. Five patients with dysphagia died (because of causes other than dysphagia) and 10 patients were discharged with a feeding tube.
Conclusion: No single trigger for a swallowing disorder in acute tetraplegia was found. A combination of multiple factors (level of tetraplegia, severity of paralysis, tracheotomy, accompanying injuries and accompanying illnesses) restricts swallowing and compensation of changes, to the extent that a swallowing disorder becomes apparent.