Bedside assessment of swallowing is predictive of an abnormal barium swallow examination

Abstract

Adequate nutritional support after thermal burn injury is essential for achieving successful patient outcomes. Dysphagia is common in burn patients. Our objective was to analyze hospitalized burn patients referred to speech pathology for swallowing evaluation. A retrospective study of burn patients admitted to our center and evaluated by speech pathology from December 2001 through July 2006 was performed. Of the 16 patients, 5 (31%) had a normal bedside swallow examination, did not undergo a modified barium swallow study (MBSS), and were excluded. Six (55%) of the 11 included patients were men. The average age was 44 +/- 18 years. All 11 patients had a thermal burn with an average total body surface area burn of 36% +/- 16%. Facial burns were present in 91% (10 of 11) of the patients, and inhalation injury was confirmed by bronchoscopy in 55% (6 of 11) of the patients. The average length of stay was 84 +/- 45 days. Of the 11 abnormal bedside assessments performed, 10 (91%) were associated with an abnormal MBSS. One patient had evidence of oral dysphagia only and one patient had evidence of pharyngeal dysphagia only. Six patients had oral and pharyngeal dysphagia, and two patients had pharyngeal and esophageal dysphagia. One tracheal-esophageal fistula was identified. A bedside assessment of swallowing performed by a speech pathologist is predictive of an abnormal modified barium swallow in burn patients. Burn patients with facial burns, inhalation injury, pneumonia, and a prolonged ICU stay are at increased risk for dysphagia. Prospective studies are necessary to determine in which patients an MBSS adds additional relevant clinical information.