Showing papers by "Robert F. Lavery published in 2016"

Severe dysphagia requiring gastrostomy following cervical spine fracture fixation

Abstract: Background The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve quickly. We hypothesized that patient and clinical factors could be used to predict severe dysphagia requiring GT placement in this population. Methods A retrospective multicenter review of all adult patients requiring operative fixation of cervical spine fractures was performed. Data on demographics, injury severity score, presence of spinal cord injury, operative approach, presence of severe traumatic brain injury, and the need and timing of tracheostomy and GT were collected. The timing, number and results of formal speech, and language pathology examinations were also recorded. Results 243 patients underwent cervical spine fixation for traumatic fractures, of which 72 (30%) required GT placement. Patients requiring gastrostomy were significantly older, 54 versus 45 years (p=0.002), and had higher injury severity scores at 24 versus 18 (p Conclusions Severe dysphagia requiring GT placement occurs commonly (30%) in patients who undergo operative fixation of cervical spine fractures. Gastrostomy placement was delayed in 50%. Tracheostomy was strongly associated with the need for GT placement. Earlier GT placement, especially in patients requiring tracheostomy, would improve patient care and disposition.