Swallowing impairment in older persons following burn injury: Validation of incidence and predictive factors for dysphagia

Background

Early retrospective data identify that dysphagia is common in older persons with burn injury, suggesting a rate of 47 %, and that it is associated with medical, burn, and nutritional outcomes.

Aims

To prospectively (1) explore the incidence, (2) describe associations, and (3) evaluate risk factors for dysphagia in patients ≥ 75 years old hospitalised with burn injury.

Methods

All patients > 75 years old admitted to Concord-Repatriation-General-Hospital with burn injury over 4 years (2019–2023) were assessed for dysphagia on presentation and were continually monitored throughout their admission. Burn injury, demographic, and nutritional data were prospectively captured and analysed for association with dysphagia.

Results

Sixty-two patients (33 male) aged 75–95 years (median=83 years) were recruited. Dysphagia was identified in 50 %. Dysphagia was associated with burn size (p = 0.002), pre-existing cognitive impairment (p = 0.000), hospital length of stay (p = 0.001), in-hospital complications (p = 0.000), feeding dependence (p = 0.002), nutritional status (p = 0.013) and enteral feeding duration (p = 0.030). Cognitive impairment was the most sensitive predictor for dysphagia at 100 % (specificity=29 %, NPV=100 %, PPV=59 %). Development of secondary comorbidities was less sensitive at 52 % (NPV 65 %), but was associated with high specificity (90 %) and PPV (84 %).

Conclusions

One in every two patients ≥ 75 years admitted with burn injury will demonstrate dysphagia during their hospital admission. Those with pre-existing cognitive impairment are most at risk.