gms | German Medical Science

Objective: 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%, the occurrence of dysphagia in this subtype of TBI has not been widely investigated. The aim of the study was to evaluate the overall frequency, clinical predictors and functional outcome of dysphagia in SDH.

Methods: A retrospective analysis was conducted including all patients admitted to the neurosurgical department of the authors´ institute between 2007 and 2020 with SDH. All patients with clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist. Functional outcome was evaluated by Glasgow outcome scale (GOS).

Results: Of 545 patients, 71 patients had dysphagia (13%). Independent predictors for dysphagia were GCS <13 at admission (OR 4.17), pneumonia (OR 2.88) and cardiovascular disease (OR 2.29). The only protective factor for dysphagia was surgical treatment (OR 0.23). After surgical treatment of SDH, the incidence of dysphagia was significantly lower compared to those with conservative treatment (11.8% vs 21.8%; OR 0.23; p=0.02). Furthermore, patients with dysphagia had significantly worse outcome compared to those without dysphagia (48.8% vs 26.4%; p<0.001).

Conclusion: Dysphagia is a frequent and relevant symptom in patients with SDH. Surgical treatment is effective in preventing dysphagia and consequently leads to improved clinical course and outcome. GCS at admission might prove useful in clinical decision pathways to risk-stratify identify patients in need of a thorough swallowing assessment by an SLP after surgery.