Cervical Fractures: Does Injury Level Impact the Incidence of Dysphagia in Elderly Patients?

Dysphagia is common in the elderly with significant consequences such as aspiration and malnutrition. This study seeks to investigate oropharyngeal dysphagia in elderly patients with cervical fractures and determine whether the level of cervical fracture impacts the incidence of swallowing dysfunction. Records of trauma patients ≥65 admitted with cervical fractures over a 76-month period to a level 1 trauma center were reviewed. History of dysphagia, stroke, tracheostomy or spinal cord injury were excluded criteria, leaving 161 patients for analysis. Evaluation of swallowing function was performed to identify dysphagia and variables were analyzed. A total of 161 patients met inclusion criteria and 42 (26.1%) had dysphagia. Patients with dysphagia were older (84.1 ± 8.93 vs. 79.9 ± 8.48, p = 0.006), had higher hospital length of stay (9.0 ± 4.48 vs 4.6 ± 3.30, p = <0.0001), and were more likely to have intensive care unit days (52.4% vs 21.8%, p = 0.0002). Non-operatively-managed patients with C1 fractures were more likely to have dysphagia than patients without C1 fractures (29.2% vs 7.1%, p = 0.0008). After regression analysis, C1 fracture increased the likelihood of dysphagia by four times (OR = 4.0; 95% CI 1.2⁻13.0). Oropharyngeal dysphagia is common in elderly patients with cervical fracture. Non-operatively-managed patients with C1 fractures are at increased risk and may benefit from more vigorous surveillance.