Nora Sherry, BS, MD, MS
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Heather Edwards, MS, CCC-SLP
Lead Speech Language Pathologist
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Maddie Chrisman, PT, DPT
Improvement Specialist CRP
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
.jpg "Lauren Alessi, MD photo")
Lauren Alessi, MD
Clinical Assistant Professor
Helen DeVos Childrens Hospital
Grand Rapids, MI
Disclosure information not submitted.
Amit Sinha, MD
Medical Director, Children's Hospital Rehabilitation Unit (CHRU)
UPMC, United States
Disclosure information not submitted.
Dennis Simon, MD
Assistant Professor of Critical Care Medicine and Pediatrics
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Barbara Gaines, MD
Associate Surgeon-in-Chief of Pediatric General and Thoracic Surgery
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Shannon Snatchko, MSN, RN, CCRN
Nurse Coordinator, CIRCLE Program
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Cindy Miller, RD, LDN
Clinical Nutritionist
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Ericka Fink, MD, FCCM
Childrens Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Title: Dysphagia and Cognitive Disability in Children Hospitalized with Traumatic Brain Injury
Introduction: Children hospitalized following traumatic brain injury (TBI) are at increased risk for dysphagia and cognitive dysfunction. Evidence based guidelines for routine hospital assessment for dysphagia and cognitive dysfunction are lacking. We sought to analyze the frequency of Speech Language Therapy (SLT) consultation and results of dysphagia and cognitive testing to inform quality improvement guidelines.
Methods: Child and injury characteristics, frequency of SLT consultation, frequency of testing and results for dysphagia and cognitive dysfunction, and neurologic outcome at hospital discharge were collected on 148 children with TBI who followed up with the Acquired Brain Injury outpatient clinic. Unfavorable outcome was defined as Pediatric Cerebral Performance Category score 4-6 at hospital discharge or change from baseline > 1.
Results: Children’s median age was 8 (interquartile range 2-13) years, and 32% were female. Fifty-two (35%) children had Glasgow Coma Score < 8, 113 (76%) were admitted to the Intensive Care Unit, and 63 (43%) had unfavorable outcome. During hospital admission, 32% had bedside clinical feeding evaluations, 53% had cognitive evaluations, and 18% had both. More children with unfavorable outcome had consultations for feeding (59% vs. 13%, p< .001) but not cognitive (57% vs. 60%, p=.866) testing. Of the 29 children who had a bedside clinical feeding evaluation by SLT, 19 (66%) had some form of dysphagia (during oral intake of either thin liquid, puree, and/or solid foods), 18 (78%) of whom had unfavorable outcome (p=.011). Of 86 children who had a bedside cognitive assessment by SLT, 81 (87%) had cognitive deficits not present at baseline, not different between unfavorable (38 [95%]) vs. favorable (43 [81%], p=.063) outcome groups. All children with dysphagia who underwent cognitive assessment (n=11) had cognitive dysfunction.
Conclusion: Children hospitalized with TBI are at high risk of dysphagia and cognitive dysfunction, but SLT consultation for assessment was variable. Prospective data are needed to inform evidence-based dysphagia and cognitive guidelines to improve recovery after pediatric TBI.