2015 Volume 19 Issue 2 Pages 117-126
Purpose: The purpose of this study was to investigate the distribution of dysphagic patients with disturbance of consciousness and the relationship between level of consciousness and resumption of full oral intake in an acute care hospital.
Subjects and Methods: We retrospectively analyzed 498 dysphagic patients with an average age of 68 (SD 15) years who received swallowing training in our acute care hospital for 4 years. We investigated the number of patients who returned to full oral intake from the viewpoint of their recovery of level of consciousness, examining changes in Dysphagia Severity Scale (DSS) and the Food Intake Level Scale, the Japan Coma Scale (JCS) between at the beginning and the end of intervention.
Results: At the beginning of intervention, alert consciousness (JCS0) was seen in only 86 patients (17%), whereas 412 (83%) were with disturbance of consciousness: 334 patients at JCS1–3, 76 at JCS10–30, and 2 at JCS100–300. Disturbance of consciousness was also found in 71% at the end of intervention.
There was a negative correlation between JCS and DSS: the coefficient of correlation was －0.28 (p＜0.001) at the beginning and was －0.47 (p＜0.001) at the end. More than 95% of patients at JCS0–2 at Occasional Aspiration Level in DSS returned to full oral feeding at the end of intervention, whereas 67% of patients at JCS3 at the same DSS level did. The results of patients at Water Aspiration Level were similar to those at Occasional Aspiration Level. Forty-five percent of all patients at Food Aspiration Level and 34% of all patients at Saliva Aspiration Level returned to full oral intake, whereas more than 70% of patients at JCS0 at both DSS levels did, and about 50% of patients at JCS1 or JCS2 did, and at JCS3 19% of patients at Food Aspiration Level and 5% at Saliva Aspiration Level did. Seventy-one percent of patients who were at Food Aspiration Level or Saliva Aspiration Level at the beginning and with disturbance of consciousness above JCS1 at the end could not achieve full oral intake.
Conclusion: Patients with dysphagia showed severe complication with disturbance of consciousness during acute phase hospitalization. The results suggest that deglutition function is correlated with level of consciousness and the outcome of dietary status is affected by the degree of improvement of consciousness during an intervention according to the initial severity of the patient’ s deglutition function. Continuous JCS assessment of consciousness might be important when considering the prognosis of dysphagia treatment efficacy.
