Risk factors for and characteristics of dysphagia development in thermal burn injury and/or inhalation injury patients: a systematic review

Mrs Emma Vo1,2, Mrs  Rochelle Kurmis2, Dr Jared Campbell3, Mrs Kathryn Heath2, Professor John Greenwood2

1Department of Speech Pathology, Royal Adelaide Hospital, Central Adelaide Local Health Network, 2 Adult Burns Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, 3The Joanna Briggs Institute, The University of Adelaide

Abstract:
Background

Dysphagia following burn injury has a reported incidence of 11%. ICU admission, mechanical ventilation, tracheostomy insertion, inhalation injury, head and neck burns and subsequent scar formation, TBSA ≥ 18%, and escharotomy are reported predictive factors for development. Dysphagia cannot reliably be determined via standard clinical bedside swallowing evaluation (CSE) post burn. Instrumental evaluation, such as Fibreoptic Endoscopic Evaluation of Swallowing (FEES), in combination with the CSE is recommended to accurately evaluate the complex and multifactorial nature of dysphagia.

Aim

To systematically review evidence regarding swallowing outcomes following burn and/or inhalation injury with the aim of describing dysphagia characteristics, including risk factors for development.

Methods

A comprehensive search was conducted per ‘a priori’ protocol, until March 2017. Critical appraisal was undertaken by two independent reviewers. Studies were included where they evaluated dysphagia following burn and/or inhalation injury using objective and/or subjective assessment tools, reported on risk factors, medical management, and investigated oral, laryngeal and/or pharyngeal phase dysphagia, dysphagia duration and/or rehabilitation requirements.

Results

4751 results following removal of duplicates were identified. Forty-one full-text articles were retrieved, with 17 eligible for inclusion. Eight reported on various objective methods for dysphagia assessment, while the remainder reported only subjective assessment methods. Three prospective studies reported on data from one patient cohort, presenting different outcome analysis or sub-analysis in each article.

Conclusion

Additional evidence pertaining to objective instrumental assessment is required to further assist identification of reliable predictive factors for post-burn dysphagia and ideal methods for rehabilitation and anticipated recovery for post-burn dysphagia.

Biography:
Emma Vo is a Senior Speech Pathologist at the Royal Adelaide Hospital. Areas of interest include dysphagia and tracheostomy management amongst the burns, neurosurgery, critical care and  trauma populations. Emma is credentialed in independent, nasoendoscopic evaluation of swallowing function.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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