TY  - JOUR
A1  - Won, Sae-Yeon
A1  - Krieger, Simon
A1  - Dubinski, Daniel
A1  - Geßler, Florian
A1  - Behmanesh, Bedjan
A1  - Freiman, Thomas Michael
A1  - Konczalla, Jürgen
A1  - Seifert, Volker
A1  - Lapa, Sriramya
T1  - Neurogenic dysphagia in subdural hematoma
T2  - Frontiers in neurology
N2  - Introduction: Dysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity, and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated yet.
Methods: All patients with SDH admitted to the author's institution between the years 2007 and 2020 were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore, the severity of dysphagia was rated according to swallowing disorder scale. Functional outcome was evaluated by the Glasgow outcome scale (GOS).
Results: Out of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8 vs. 21.8%; OR 0.23; p = 0.02). Independent predictors for dysphagia were GCS < 13 at admission (OR 4.17; p < 0.001), cardiovascular disease (OR 2.29; p = 0.002), and pneumonia (OR 2.88; p = 0.002), whereas the operation was a protective factor (OR 0.2; p < 0.001). In a subgroup analysis, right-sided SDH was an additional predictor for dysphagia (OR 2.7; p < 0.001). Overall, patients with dysphagia improved significantly under the SLP treatment from the initial diagnosis to hospital discharge (p < 0.01). However, a subgroup of patients with the most severe grade of dysphagia showed no significant improvement. Patients with dysphagia had significantly worse outcomes (GOS 1–3) compared to those without dysphagia (48.8 vs. 26.4%; p < 0.001).
Conclusion: Dysphagia is a frequent symptom in SDH, and the early identification of dysphagia is crucial regarding the initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.
KW  - subdural hematoma
KW  - dysphagia
KW  - speech and language pathologist
KW  - predictor
KW  - functional outcome
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/79389
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-793891
SN  - 1664-2295
VL  - 12
IS  - art. 701378
SP  - 1
EP  - 7
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  -