Dysphagia in older persons following severe burns: Burn location is irrelevant to risk of dysphagia and its complications in patients over 75 years

doi:10.1016/j.burns.2018.07.010

Burns

Volume 44, Issue 8, December 2018, Pages 1997-2005

https://doi.org/10.1016/j.burns.2018.07.010 Get rights and content

Highlights

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First documented study on dysphagia in the older person with burn injury.
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Dysphagia is highly prevalent in the older person with burn injury.
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Dysphagia in the older person with burns is associated with increased morbidity and mortality.

Abstract

Background

Management of burns in older persons is complex with evidence indicating advanced age is associated with elevated risk for morbidity and mortality. Dysphagia and its sequelae may further increase this risk.

Aims

(1) Determine the prevalence, and (2) identify risk factors for dysphagia in patients admitted with severe burn injury over 75 years.

Methods

All patients >75 years admitted to Concord Repatriation General Hospital with severe burn injury over a 4-year period (2013–2017) were assessed for dysphagia on presentation and continually monitored throughout their admission. Burn injury, demographic and nutritional data were captured and analysed for association with and predictive value for dysphagia.

Results

Sixty-six patients (35 male; 31 female) aged 75–96 years (median 82 years) were recruited. Dysphagia was identified in 46.97% during their hospital admission. Dysphagia was significantly associated with burn size, pre-existing cognitive impairment, mechanical ventilation, duration of enteral feeding, hospital length of stay, in-hospital complications and mortality. No association was identified between burn location, burn mechanism, surgery and dysphagia. Burn size and Malnutrition Screening Tool score were found to be independent predictors for dysphagia.

Conclusions

Dysphagia prevalence is high in older persons with burns and is associated with increased morbidity and mortality, regardless of burn location.

Section snippets

Background

Burns are recognised as a common form of trauma [1], [2], [3]. Individuals recognised to be at greatest risk of burn injury in the Australian adult population are of Aboriginal and Torres Strait Islander descent, young males and older persons [4], [5], [6], [7]. Management of the older person with burn injury is complex with evidence indicating that advanced age is associated with elevated risk for morbidity and mortality from the time of admission [8]. The presence of dysphagia, characterised

Patient population

All patients aged 75 years or above admitted to the NSW Statewide Burn Injury Service at Concord Repatriation General Hospital for inpatient care of a burn injury from July 2013 to June 2017 were considered for inclusion within the study. As a part of routine clinical practice, each patient’s swallow function was assessed on admission and continually monitored over the course of their hospital stay. Patients were excluded from the study if the primary diagnosis was not burn injury (e.g.

Results

A total of 66 participants (35 male; 31 female) aged 75–96 years (median 82 years, SD 5.18) were recruited to participate over the 3 year study period. Size of the burn injury ranged between 1–31% total body surface area (TBSA) with a mean burn area of 7.17% (SD 6.82). The most frequent cause of burn injury was scald (62%), followed by flame (21%) and to a lesser extent contact (12%) and chemical (5%). The torso (53%) and the lower limbs (48%) were the most commonly affected areas of the body

Discussion

This study illustrates that the presence of dysphagia, as well as the risk for and presence of malnutrition, in the older person with severe burn injury is high. Dysphagia is more apparent in patients with greater burn surface area, pre-existing cognitive impairment or those who receive mechanical ventilation as part of their treatment. Further to this, the presence of dysphagia is associated with increased length of hospital stay, malnutrition, duration of enteral feeding and mortality.

Conclusion

Dysphagia is a significant issue within the older person burn injury population; being more evident in those with larger burn areas, pre-existing cognitive impairment and diminished nutritional state but not necessarily related to burn location. Furthermore, the MST score and percentage TBSA were identified to be independent predictors for dysphagia development within this cohort. These study findings suggest that timely assessment and management of swallow function in the older person with

Conflict of interest

The authors have no conflicts of interest to declare in both the conduct of this study or preparation of this manuscript.

All authors contributed to the conception and design of this study, data analysis and interpretation, preparation and verification of this final manuscript prior to submission for publication.

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Short- and long term hyposmia, hypogeusia, dysphagia and dysphonia after facial burn injury – A prospective matched cohort study
2023, Burns
Citation Excerpt :
Taking into account our current understanding of systemic post-burn catabolic hypermetabolism, the significance of proper oral intake of high-caloric nutrients cannot be underestimated for wound healing and overall recovery [3,25]. Dysfunctional swallowing (dysphagia) is a well-described problem of patients with burn injuries: In a large prospective cohort study it was shown that about one in ten burn survivors experiences dysphagia during the course of their treatment and that risk factors such as increased burn severity, the presence of inhalation injury (II), burns to the head and neck, advanced age and the need for intensive care are associated with dysphagia [26]; these findings and the predictive risk factors have been further validated and characterized in subsequent studies [27–29]. Likewise, dysphonia is a well-known problem in burn patients, particularly those who require prolonged mechanical ventilation and tracheostomy [30], with functional outcomes depending on factors such as the use of surgical versus dilational tracheostomy and endotracheal tube size [31,32].
Facial burns frequently occur in occupational or household accidents. While dysphagia and dysphonia are known sequelae, little is known about impaired smell and taste after facial burns.
In a prospective observational controlled study, we evaluated hyposmia via the Sniffin’ Stick Test (SnS), hypogeusia via a taste strip test, and dysphonia and dysphagia via validated questionnaires acutely and one-year after burn, respectively. A matched control group consisting of a convenience sample of healthy volunteers underwent the same assessments.
Fifty-five facial burn patients (FB) and 55 healthy controls (CTR) were enrolled. Mean burn size was 11 (IQR: 29) % total body surface area (TBSA); CTR and FB were comparable regarding age, sex and smoking status. Acutely, hyposmia was present in 29% of the FB group (CTR: 9%, p = 0.014) and burn patients scored worse on the SnS than CTR (FB: 10; CTR: 11; IQR: 2; p = 0.013). Hyposmia per SnS correlated with subjective self-assessment. Hyposmia and SnS scores improved over time (FB acute: 10.5 IQR: 2; FB one year: 11; IQR: 2; p = 0.042) and returned to normal at one-year post burn in most patients who completed the study (lost to follow-up: 21 patients). Taste strip scores were comparable between FB and CTR, as was the acute prevalence of dysphagia and dysphonia.
Hyposmia acutely after facial thermal trauma appeared frequently in this study, especially when complicated by inhalation trauma or large TBSA involvement. Of all complete assessments, a fraction of burn patients retained hyposmia after one year while most improved over time to normal. Prevalence of dysphonia, dysphagia and hypogeusia was comparable to healthy controls in this study, perhaps due to overall minor burn severity.
Dysphagia in the burn patient: Experience in a National Burn Reference Centre
2019, Burns
Citation Excerpt :
To date, there is only one study that estimates the prevalence of dysphagia in burn patients [32]. The study found 46.97% of dysphagia in older patients (>75 years) with severe burns [32]. However, it has been shown that the physiology of swallowing undergoes changes with age, increasing the risk of developing dysphagia [42,43].
Major burn patients are exposed to different invasive procedures for wound management or medical stabilization. Dysphagia is a frequent adverse effect of burns in the presence of invasive airway procedures and facial wounds.
To estimate the prevalence of dysphagia, to determine the degree of severity, and to report clinical characteristics that could contribute to the appearance of dysphagia in patients admitted to a National Burn Reference Centre.
An observational cross-sectional study was conducted in a burn reference centre over a 6-month period. All patients admitted to the burn service of a National Reference Centre were included. A clinical bedside swallowing assessment was performed in patients referred to a Speech-Language Pathologist (SLP). The presence or absence of dysphagia was evaluated, and the degree of severity was measured according to the Dysphagia Outcome and Severity Scale (DOSS).
Fifty-four participants were recruited. The prevalence of dysphagia over a 6-month period was 27.78% (n = 15) of the total burn patients admitted to the Burn Unit. The severity of dysphagia varied from mild (26.7%), mild-moderate (33.3%), moderate (20%), moderate-severe (13.3%), to severe (6.7%). All dysphagia patients had orotracheal intubation history with an average length of 18 days, as opposed to the non-dysphagia group, of which 75% of the participants had orotracheal intubation history for an average of 8.5 days. Statistically non-significant associations were found between dysphagia and demographic aspects or clinical characteristics (p > 0.05).
27.78% of burn patients presented dysphagia, with differences in the degree of severity. Presence and duration of orotracheal intubation stands out as a condition of interest. The SLP inclusion in the burn team is presented as a valuable input in order to minimize risks associated with swallowing impairment.
Prevalence of Oropharyngeal Dysphagia and Risk of Pneumonia, Malnutrition, and Mortality in Adults Aged 60 Years and Older: A Meta-Analysis
2022, Gerontology
A new nomogram to predict the need for tracheostomy in burned patients
2021, European Archives of Oto-Rhino-Laryngology
Influence of Inhalation Injury on Incidence, Clinical Profile and Recovery Pattern of Dysphagia Following Burn Injury
2020, Dysphagia
Burns Impair Blood-Brain Barrier and Mesenchymal Stem Cells Can Reverse the Process in Mice
2020, Frontiers in Immunology

View full text

Dysphagia in older persons following severe burns: Burn location is irrelevant to risk of dysphagia and its complications in patients over 75 years

Highlights

Abstract

Background

Aims

Methods

Results

Conclusions

Section snippets

Background

Patient population

Results

Discussion

Conclusion

Conflict of interest

Burns

Burns

Burns

Burns

J Am Med Dir Assoc

Nutrition

Nutrition

Clin Nutr

Total burn care

The association between hypothermia, prehospital cooling, and mortality in burn victims

Acad Emerg Med

Rates of compliance with first aid recommendations in burns patients

J Burn Care Res

Bi-national burns registry annual report

Burns and scalds

Influence of comorbidities and age on outcome following burn injury in older adults

J Burn Care Res

The effect of endotracheal tube size on voice and swallowing function in patients with thermal burn injury: an evaluation using the Australian Therapy Outcome Measures (AusTOMS)

Int J Speech Lang Pathol

Management of dysphagia in toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS)

Dysphagia

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

J Burn Care Res

Pattern of dysphagia recovery after thermal burn injury

J Burn Care Rehabil

The challenges of dysphagia management and rehabilitation after extensive thermal burn injury: a complex case

J Burn Care Res

Physiological characteristics of dysphagia following thermal burn injury

Dysphagia

Clinical progression and outcome of dysphagia following thermal burn injury: a prospective cohort study

J Burn Care Res

Incidence and predictive factors for dysphagia after thermal burn injury: a prospective cohort study

J Burn Care Res