Oropharyngeal dysphagia management in cervical spinal cord injury patients: an exploratory survey of variations to care across specialised and non-specialised units

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0175-y · Published: March 11, 2019

Spinal Cord Injury Critical Care Rehabilitation

Simple Explanation

This study explores how hospitals in the UK manage swallowing difficulties (dysphagia) in patients with cervical spinal cord injuries (CSCI). It looks at both specialized spinal units and general intensive care units to see if there are differences in how they treat these patients. The study found that there are variations in the clinical management of respiratory impairments and oropharyngeal dysphagia between specialized and non-specialized units. This can lead to increased risk of respiratory complications and impact patient outcomes. The researchers suggest that there is a need for national guidelines to ensure that all hospitals provide the best and most consistent care for CSCI patients with dysphagia.

Study Duration

August 2014 to January 2015

Participants

219 staff members from 92 hospitals in the UK

Evidence Level

Not specified

Key Findings

1
Non-specialized units showed variations in respiratory management, including limited use of vital capacity measures and graduated weaning programs.
2
Specialized units employed a multi-disciplinary approach to the clinical management of nutritional needs.
3
Instrumental swallowing assessments (FEES and VFS) were used more frequently by staff in specialized units.

Research Summary

This study investigated the clinical care of respiratory dysfunction, oropharyngeal dysphagia and nutrition in CSCI patients within specialized and non-specialized units across the UK. The survey results demonstrate variations in care that can have an impact on these functions and the negative consequences of dysphagia. With no plans to increase respiratory bed capacity in specialised units, clinical guidance is required to support multi-disciplinary teams to deliver safe and consistent care.

Practical Implications

Development of Clinical Guidelines

The study highlights the need for the development of clinical guidelines to ensure best practice and consistent care across all units managing CSCI patients.

Improved Patient Outcomes

Addressing the variations in clinical management between specialized and non-specialized units can improve patient outcomes and reduce the risk of respiratory complications.

Multidisciplinary Approach

Encouraging a multidisciplinary approach to clinical management, especially regarding nutritional needs, can benefit CSCI patients in non-specialized units.

Study Limitations

1
Recruitment relied on purposive and snowball sampling, making a response rate difficult to calculate.
2
Sample sizes for each group varied considerably making statistical comparisons inappropriate.
3
Some professional groups were less well represented.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury