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Tracheostomy is associated with increased aspiration rates, and swallowing disorders have not been well-studied in trauma patients with tracheostomy. Swallowing evaluations were conducted in 224 patients (102 trauma and 122 nontrauma patients). Half of the patients in each group had tracheostomies. Bedside swallow studies were conducted in 40 patients, videofluoroscopy swallow studies in 100 patients, and both studies in 84 patients. ?2, Fisher's exact test, Cramer's V, and descriptive statistics were used for data analysis. Aspiration occurred in 35 per cent (36 of 102) of trauma patients with or without tracheostomy and in 36 per cent (22 of 61) of nontrauma patients with tracheostomy. Aspiration with and without penetration was observed in 54 per cent of trauma patients (55% with tracheostomy) compared with 67 per cent of all nontrauma patients (61% with tracheostomy). Trauma patients with head injuries exhibited 41 per cent (26 of 63) aspiration and 68 per cent (43 of 63) dysphagia compared with 26 per cent (10 of 39) and 59 per cent (23 of 39) in trauma patients with other injuries. There was a lower incidence of dysphagia in trauma patients (65% versus81% in nontrauma) and in patients with tracheostomy (71% versus77% without tracheostomy). Tracheostomy was not associated with increased dysphagia or aspiration.

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (=6 RFs) VTE scores (P= 0.172). Incidence was statistically different (3% vs7.2%, P= 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (=5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients withor withoutRFs: previous VTE (27.3% vs5.6%, odds ratio (OR) 6.628, P= 0.024), spinal cord injury (22.6% vs5%, OR 5.493, P= 0.001), pelvic fractures (11.4% vs5.1%, OR 2.373, P= 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs4.2%, OR 2.639, P= 0.014). On reanalyzing patients with =5 RFs vs<5RFs, obesity (14.3 vs6.1%, P= 0.007), malignancy (5.6% vs0.6%, P= 0.006), coagulopathy (10.8% vs1.8%, P= 0.000), and previous VTE (3.2% vs0%, P= 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score (P= 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P= 0.001). Increasing age was a weak risk factor (0.03 r, P= 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of =15 and 25 had higher DVTs compared with the ones with lower injury severity score levels (P= 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.