Will They Aspirate? Predictive and Protective Factors for Aspiration in Acute Trauma Patients With Tracheostomy

Background: Trauma is a leading cause of death and disability in the United States of America. Tracheostomy is a common intervention in trauma patients. Relationship between tracheostomy and swallowing remains ambiguous. The primary aim of this study is to investigate predictive factors for aspiration in trauma patients undergoing tracheostomy tube placement. Methods: A retrospective chart review was completed on all adult patients (18 or older) admitted to the trauma service of a Level I trauma center between 2015 and 2018 who underwent tracheostomy tube placement and participated in an objective swallow study. A total of 240 eligible patients were identified. Presence of penetration or aspiration was determined by the highest Penetration Aspiration Scale (PAS) score with scores of 2-5 indicative of penetration, and 6-8 of aspiration. Counts and proportions are reported for categorical data. Mean and standard deviation are reported for continuous data. Chi-squared Test or Fisher’s Exact Test are used to analyze categorical data. Continuous variable groups were compared using a T-test or the Wilcoxon rank sum test. Significance was determined by corresponding P-value < .05. Results: When comparing variables by the presence or absence of aspiration, we found several individual predictors of aspiration including age, BMI, TBI, GCS, days intubated, and number of intubations. For the final model, significant predictors of aspiration in the presence of other significant individual predictors included age, BMI, GCS, and days intubated. After controlling for other significant factors, geriatric trauma patients (age 55+) had 3.3 times greater odds of aspiration than patients under age 55. Obesity had a protective effect for aspiration with 54% lower odds of aspiration than those with a normal or underweight BMI, and a 69% lower odds of aspiration than those who were overweight. GCS was associated with a 22% decrease in the odds of aspiration for every 1-unit increase in GCS. And finally, for each 1-d increase in days intubated, patients had an 11% increase in the odds of aspiration. Conclusions: Our study examined trauma patients who underwent tracheostomy tube placement to investigate risk factors associated with aspiration. Patient age, days intubated, and GCS were significantly related to the presence of aspiration. However, age greater than 55 was the most predictive patient medical factor for aspiration. Surprisingly, obesity had a strongly supported protective effect, which was not anticipated.