Influence of Inhalation Injury on Incidence, Clinical Profile and Recovery Pattern of Dysphagia Following Burn Injury.
N A Clayton, E C Ward, A F Rumbach and 3 others
PMID 32103328WHAT IT FOUND
In 38 burn patients with confirmed inhalation injury, 34 had swallowing problems and 78.9% were severe at first assessment.
Most recovered by discharge, but reported mean time to start oral intake was 24.69 days and to resolve dysphagia 29.79 days.
Key findings
01Dysphagia was present in 34 of 38 patients with confirmed inhalation injury, and 78.9% had severe dysphagia at initial assessment.
02The text reported mean days to initiate oral feeding as 24.69, mean days to resolve dysphagia as 29.79, and mean days of enteral feeding as 45.03.
03Compared with a published non-inhalation burn cohort, the inhalation cohort had dysphagia in 89.47% versus 5.6% and mean dysphagia resolution of 29.79 days versus 1.67 days.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was retrospective and relied on routine clinical records, so assessments were not standardised or scheduled at fixed time points. The inhalation group was small (38 patients) and came from one statewide burns service, which limits generalisability. All participants had head and neck burns and flame injury, and most were mechanically ventilated, so the contribution of inhalation injury cannot be separated from other burn and intensive care factors. Dysphagia was mainly diagnosed by clinical swallowing examination; only 7 of 38 had FEES, and those data were not analysed, so milder or subclinical swallowing problems may have been missed. The comparison cohorts were historical and from a different unit, so differences in practice may have affected outcomes, especially enteral feeding duration. Enteral feeding duration was not a direct marker of dysphagia because many burn patients need tube feeding for metabolic and wound-healing reasons. The Functional Oral Intake Scale has limitations in this population because non-oral feeding may be needed for reasons other than swallowing. The paper reports different mean days to dysphagia resolution in the text and Table 1 (29.79 days versus 42.9 days), so the exact recovery timing is uncertain.
The easy way to misread this
Do not read the high dysphagia rate as proof that inhalation injury alone caused the swallowing problems. All patients had head and neck burns, 37 of 38 were mechanically ventilated for mean 9.62 days, and 7 of 38 had a tracheostomy, so these factors cannot be separated from inhalation injury in this retrospective record review. The study also used routine clinical assessments rather than standardised outcome measures.