Clinical Predictors of Dysphagia in Acute and Subacute Traumatic Cervical Spinal Cord Injury: A Retrospective Observational Study

Abstract

Using the first videofluoroscopic swallowing study (VFSS), we aimed to identify clinical predictors of dysphagia in patients with acute and subacute traumatic cervical spinal cord injury (TCSCI). This retrospective chart review included 143 adults, who were diagnosed with TCSCI and underwent their first VFSS between 2018 and 2021. Patients with alert mental status and no history of traumatic brain injury or preexisting conditions causing dysphagia were included. The neurological status was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Dysphagia was evaluated using the penetration-aspiration scale and the pharyngeal residue severity rating scale. Cervical alignment was assessed by measuring the O-C2 and C2-C6 angles and the narrowest oropharyngeal diameter. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of dysphagia. Tracheostomy and age ≥ 65 years were identified as significant predictors of dysphagia. Tracheostomy was strongly associated with a higher risk of penetration-aspiration (odds ratio [OR] = 8.33, P = 0.001), whereas age ≥ 65 years was a significant predictor of pharyngeal residue (OR = 4.45, P < 0.001). Despite showing a trend toward significance in univariate analysis, increased cervical lordosis (C2-C6 angle) was not confirmed as an independent predictor in multivariate analysis. Tracheostomy and advanced age are significant early predictors of dysphagia in acute and subacute TCSCI. Early bedside screening, followed by timely instrumental assessment such as VFSS, is essential to detect dysphagia before initiating oral intake and to implement preventive strategies that may reduce aspiration-related complications.

Keywords: Dysphagia; Penetration-aspiration scale; Pharyngeal residue; Tracheostomy; Traumatic cervical spinal cord injuries; Videofluoroscopic swallowing study.