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. 2022 Jan 26:12:701378.
doi: 10.3389/fneur.2021.701378. eCollection 2021.

Neurogenic Dysphagia in Subdural Hematoma

Sae-Yeon Won  1 , Simon Krieger  1 , Daniel Dubinski  1 , Florian Gessler  1 , Bedjan Behmanesh  1 , Thomas M Freiman  1 , Juergen Konczalla  1 , Volker Seifert  1 , Sriramya Lapa  2
Affiliations

Neurogenic Dysphagia in Subdural Hematoma

Sae-Yeon Won et al. Front Neurol. .

Abstract

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.

Keywords: dysphagia; functional outcome; predictor; speech and language pathologist; subdural hematoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow-chart of dysphagia screening. SDH, subdural hematoma; GCS, Glasgow Coma Scale; SLP, Speech-language-pathologist.
Figure 2
Figure 2
Significantly higher rate of dysphagia in patients with conservative treatment compared to operative treatment of subdural hematoma at first SLP evaluation (p < 0.05). At discharge, the rate of dysphagia was comparable for both groups (p = n.s.).
Figure 3
Figure 3
Functional feeding status scale in patients with dysphagia divided by operative and conservative treatment of subdural hematoma.
See this image and copyright information in PMC

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