From delay to detection: Dysphagia patterns in tracheostomised ICU patients in South Africa

Abstract

Background: Dysphagia in tracheostomised patients is highly prevalent but often underdiagnosed, especially in resource-constrained settings such as South Africa. Delays in referral and limited access to instrumental assessments further compromise the quality of care. There is limited data regarding the incidence and severity of dysphagia in patients with tracheostomies within this context.
Objectives: This study aimed to evaluate the incidence of dysphagia in tracheostomised patients at a South African private intensive care unit (ICU) in order to understand and explore the need for context-appropriate, standardised practices of care in this population.
Method: A retrospective file review was conducted on 68 adult patients who underwent fibreoptic endoscopic evaluation of swallowing (FEES) between July 2022 and January 2024. Data were extracted for 42 patients who had a tracheostomy at the time of assessment. Dysphagia severity was rated using the Penetration-Aspiration Scale (PAS). Descriptive statistics were used to analyse incidence, severity, referral timing and ICU stay duration.
Results: A total of 66.6% of tracheostomised patients assessed using FEES presented with dysphagia. Penetration-aspiration scores showed a polarised distribution, with 33.3% scoring 1 (normal) and 28.6% scoring 8 (silent aspiration). The average time to referral was 25.7 days, with FEES completed after 32.4 days. These delays suggest missed opportunities for early identification.
Conclusion: The findings highlight a high incidence of dysphagia and delays in referral, underscoring the need for standardised practices of care to support earlier identification and management.
Contribution: Implementing context-appropriate protocols may improve referral efficiency, optimise resource use and enhance patient outcomes in South African ICUs.