Objectives: 80% of severe TBI suffer from swallowing disorders, with complications of pneumonia, and denutrition impacting their outcome. The aim of this retrospective study was to look for a correlation between feeding modalities (FOIS, functional oral intake scale) and the state of consciousness (WHIM), or the level of post traumatic amnesia (GOAT). We also looked for a benefit of VFSS over the over evaluation modalities, and an exploratory correlation analysis was realized.
Design: We reviewed the clinical information of 68 VS (vegetative state) or MCS (minimal conscious state) patients (mean age 44 ± 6) regarding oral feeding and psychometric parameters. VS or MCS diagnosis was made after repeated behavioural assessments using the WHIM scale (Wessex Head Injury Matrix). Post traumatic amnesia was assessed using the Galvestone outcome amnesia test (GOAT). Swallowing evaluation was made using either videofluroscopy (VFSS), fiber endoscopy (FEES) or clinical examination. The main outcome statistics were performed using Pearson correlation analysis.
the feeding modality FOIS depended on the level of consciousness evaluated by WHIM (𝜌= 0.60; p < 0.001). A VFSS evaluation seemed to increase that correlation (𝜌= 0.80; p < 0.001), and to decrease the time needed to switch from semi-liquid to solid texture in oral feeding. The level of post-traumatic amnesia measured by GOAT (𝜌= 0.34; p < 0.05) was also correlated to FOIS. The effect of the coma arousal unit on refeeding was important d = 1.6, with an increase in FOIS of 3. There was still a positive evolution of FOIS after discharge.
FOIS is strongly correlated to WHIM and moderately correlated to GOAT, suggesting an impact of post traumatic amnesia on swallowing. GOAT and WHIM scales could be used to determine the more appropriate moment to perform VFSS, adjusting the benefice risk balance in this frail population. Swallowing stimulation should be maintained after discharge.