Includes bibliographical references / South Africa has a high incidence of injury-related disorders, such as traumatic brain injury (TBI) as a result of motor vehicle accidents and assault. Dysphagia is a common sequela of TBI, which may result in malnutrition or aspiration pneumonia. There is limited epidemiological data available for TBI and dysphagia in South Africa which is important for health care planning. There is also inadequate literature reporting predictive factors for dysphagia and health outcomes of patients with TBI and swallowing disorders for the South African context, which would provide management guidelines for Speech-Language Pathologists (SLPs) for patients with TBI and dysphagia. This study aims to begin to provide up-to-date information regarding the incidence of TBI and the prevalence of dysphagia in the population with TBI in Bloemfontein, South Africa. Predictive factors for dysphagia and health outcomes were also investigated in order to provide management guidelines for TBI-related dysphagia for SLPs. A prospective cohort study followed 77 participants aged 18 to 68 years (M = 33.1) with mild to severe traumatic brain injury, admitted to 2 state and 2 private hospitals in the Bloemfontein metropole, South Africa, to investigate the incidence of TBI and the prevalence of TBI-related dysphagia in the adult population in 2013. Participants were tracked from admission to hospital to discharge. Demographic and medical data was collected for each participant, including: gender, age, TBI aetiology, means of nutritional intake, respiratory status, length of hospital stay, and number of speech therapy sessions. Glasgow Coma Scale (GCS) scores at time of admission, swallowing evaluation, and discharge were noted as an indicator of TBI severity and each participant was assessed with the Mann Assessment of Swallowing Ability on admission and prior to discharge to assess the presence of dysphagia. The incidence of TBI for the Bloemfontein metropole was 353 per 100,000 people and was greater in the male than in the female population (11.83:1). The main mechanism for TBI in Bloemfontein was interpersonal violence (67.53%), followed by road traffic accidents (motor and pedestrian vehicle accidents; 23.38%). The prevalence rate for dysphagia was 32%. Twenty-eight percent of those who presented with dysphagia also aspirated. Severe TBI (GCS ≤ 8) was identified as a predictive factor for dysphagia. Participants with dysphagia had longer hospital stays (days; M = 22.04, SD = 17.67) than those with normal swallowing (M = 6.23, SD = 4.28), t(75) = 6.13, p < .001, and took significantly more days to achieve oral intake (M = 6.23, SD = 10.32) than those without dysphagia (M = .31, SD = 1.41), t(75) = 4.08, p < .001. Ventilation was associated with longer hospital stays, rs(25) = -.47, p = .02 and longer duration until achievement of oral intake, rs(22) = -.80, p < .001. Tracheotomised participants also had significantly longer hospital stays, rs(25) = -.67, p < .001, and took longer to achieve oral intake, rs(22) = -.52, p = .01. An increased period of time with a tracheostomy was also significantly associated with mortality, χ2(2, n = 11) = 6.52, p = .04. Participants with dysphagia (M = 3.84, SD = 5.44) required significantly more therapy sessions with an SLP than those without dysphagia (M = .15, SD = .64), t(75) = 4.85, p < .001, and those with low GCS scores were significantly less likely to achieve oral intake prior to discharge, rs(25) = -.45, p = .02, and had longer hospital stays than participants with mild head injuries, rs(25) = -.49, p = .01. All participants who received nutrition via nasogastric tubes returned to oral intake; however, individuals who had percutaneous endoscopic gastrostomies did not achieve oral intake prior to discharge. It is recommended that objective swallowing evaluations be conducted for patients admitted with severe TBIs, and patients with mild and moderate TBIs be screened to determine the presence of dysphagia. TBI prevention initiatives should be developed to reduce the incidence of TBI, specifically in the young adult male population.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/16646 |
| Date | January 2015 |
| Creators | Rossouw, Joanne Courtney |
| Contributors | Singh, Shajila |
| Publisher | University of Cape Town, Faculty of Health Sciences, Division of Communication Sciences and Disorders |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MSc (Speech-Language Pathology) |
| Format | application/pdf |
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