Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources.

OBJECTIVE: To determine if comorbid dysphagia in all hospitalized patients has the potential to prolong hospital stay and increase morbidity. Dysphagia is increasingly prevalent with age and comorbid medical conditions. Our research group has previously shown that dysphagia is a bad prognostic indicator in patients with stroke. DESIGN: Analysis of national database. MAIN OUTCOME MEASURES: The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medical conditions. Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated. RESULTS: There were over 77 million estimated hospital admissions in the period evaluated, of which 271,983 were associated with dysphagia. Dysphagia was most commonly associated with fluid or electrolyte disorder, esophageal disease, stroke, aspiration pneumonia, urinary tract infection, and congestive heart failure. The median number of hospitalization days for all patients with dysphagia was 4.04 compared with 2.40 days for those patients without dysphagia. Mortality increased substantially in patients with dysphagia associated with rehabilitation, intervertebral disk disorders, and heart diseases. CONCLUSIONS: Dysphagia has a significant impact on hospital length of stay and is a bad prognostic indicator. Early recognition of dysphagia and intervention in the hospitalized patient is advised to reduce morbidity and length of hospital stay.

The voice and laryngeal dysfunction in stroke: a report from the Neurolaryngology Subcommittee of the American Academy of Otolaryngology-Head and Neck Surgery.

OBJECTIVE: Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It affects as many as 5% of the population over 65 years old, and this number is growing annually due to the aging population. A significant portion of stroke patients that initially survive are faced with the risk of aspiration, as well as quality-of-life issues relating to impaired communication. The goal of this paper is to define the scope of practice in otolaryngology for these patients, and to review pertinent background literature. STUDY DESIGN: Consensus report and retrospective literature review. RESULTS: Otolaryngology involvement in these patients is critical to their rehabilitation, which often requires an interdisciplinary team of specialists. This committee presentation explores epidemiological data regarding the impact of stroke and its complications on hospitalizations. A pertinent review of neuroanatomy as it relates to laryngeal function is also discussed. State-of-the-art diagnostic and therapeutic procedures are presented. CONCLUSION: There is a well-defined set of diagnostic and therapeutic options for laryngeal dysfunction in the stroke patient. SIGNIFICANCE: Otolaryngologists play a critical role in the interdisciplinary rehabilitation team.

The fluorescence of thyroid tissue.

OBJECTIVE: To investigate the fluorescent characteristics of different thyroid tissues. STUDY DESIGN: Fresh ex vivo thyroid tissue was surfaced scanned with a fluorescence spectrophotometer. Resultant spectra were evaluated via interpeak ratios. RESULTS: Interpeak ratios of all histologies were found to be significantly different from each other (P < 0.001). The diagnostic sensitivity and specificity of fluorescent spectroscopy was 86% and 91% for thyroid nodule capsule, 78% and 59% for papillary thyroid carcinoma, and 82% and 63% for normal thyroid, respectively. CONCLUSION: Fluorescent spectroscopy can been used to identify significant differences in the fluorescent characteristics of various thyroid histologies. SIGNIFICANCE: This study is the first investigation of the fluorescence of thyroid tissue. The diagnostic ability of fluorescent spectrometry may allow it to be used as a localization aid for fine needle aspiration, using optical fiber probes. Further investigations may enhance the sensitivity and specificity of fluorescent spectrometry allowing it to replace or compliment fine needle aspiration. EBM RATING: B-3.