Uncovering a Silent Threat: Early bedside dysphagia screening to prevent aspiration in cervical spine fractures in older people

Introduction: Dysphagia is common in older people and is associated with aspiration and respiratory complications, particularly in those with cervical spine fractures1. A pilot study (2021) led to standards of care (SOP), developed with SLT team, for staff training to initiate early bedside dysphagia screening to mitigate respiratory complications and improve outcomes. 

Aim: To evaluate whether bedside dysphagia screening in older patients admitted with cervical spine fractures can mitigate aspiration and respiratory complications.

Method: A retrospective cohort study using electronic records was conducted across two cycles (January – July 2024; April – October 2025) at a major trauma centre. Patients aged ≥65 years admitted with cervical spine fracture were included. Exclusions were spinal cord injury, tracheostomy, inability to sit to 90°, or pre-existing dysphagia (established modified diet).  Data was collected about fracture location, dysphagia screening outcomes, SLT referral, aspiration pneumonia, and mortality.

Results: In 2024, of 68 patients included; 35 (51.4%) were managed in a hard collar. Only 6 (8.8%) had documented dysphagia assessments. In 2025, 24 (82.9%) of 29 patients were treated in a hard collar. 10 patients (34.5%) underwent early dysphagia screening, a 25.7% increase in screening between cycles. Aspiration pneumonia or LRTI occurred in 4 patients in 2024 (no screening).  In 2025, 3 patients developed aspiration pneumonia or LRTI; 2 had SLT assessment with eat-and-drink-at-risk decisions. Mortality was 8.8% in 2024 with no aspiration-related deaths, and 10.3% in 2025, including one aspiration-related death in an eat-and-drink-at-risk patient. None of the patients admitted under non spinal surgical teams (20.7%) had documented swallow assessments.

Conclusion: Early bedside dysphagia screening reduces rates of aspiration, death and length of stay in older patients with cervical spine fractures. Although screening rates were low overall, targeted staff training can improve this. This shows that education can positively influence practice and highlights need for standardisation.