title: Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction.
abstract: This study investigated the influence of age, National Institutes of Health Stroke Scale (NIHSS) score, time from stroke onset, infarct location and volume in predicting placement of a percutaneous endoscopic gastrostomy (PEG) tube in patients with severe dysphagia from an acute-subacute hemispheric infarction. We performed a retrospective analysis of a hospital-based patient cohort to analyze the effect of the aforementioned variables on the decision of whether or not to place a PEG tube. Consecutive patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for acute ischemic stroke, Current Procedural Terminology (CPT)-4 codes for a formal swallowing evaluation by a speech pathologist, and procedure codes for PEG placement over a 5-year period from existing medical records at our institution. Only patients with severe dysphagia were enrolled. A total of 77 patients met inclusion criteria; 20 of them underwent PEG placement. The relationship between age (dichotomized; < and ≥75 years), time from stroke onset (days), NIHSS score, acute infarct lesion volume (dichotomized; < and ≥100 cc), and infarct location (ie, insula, anterior insula, periventricular white matter, inferior frontal gyrus, motor cortex, or bilateral hemispheres) with PEG tube placement were analyzed using logistic regression analysis. In univariate analysis, NIHSS score (P = .005), lesion volume (P = .022), and presence of bihemispheric infarction (P = .005) were found to be the main predictors of interest. After multivariate adjustment, only NIHSS score (odds ratio [OR], 1.15; 90% confidence interval [CI], 1.02-1.29; P = .04) and presence of bihemispheric infarcts (OR, 4.67; 90% CI, 1.58-13.75; P = .018) remained significant. Our data indicates that baseline NIHSS score and the presence of bihemispheric infarcts predict PEG placement during hospitalization from an acute-subacute hemispheric infarction in patients with severe dysphagia. These results require further validation in future studies.
authors.affiliation: Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. skumar@bidmc.harvard.edu
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.forename: Susan
authors.initials: S
authors.lastname: Langmore
authors.forename: Richard P
authors.initials: RP
authors.lastname: Goddeau
authors.forename: Adel
authors.initials: A
authors.lastname: Alhazzani
authors.forename: Magdy
authors.initials: M
authors.lastname: Selim
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Lin
authors.initials: L
authors.lastname: Zhu
authors.forename: Adnan
authors.initials: A
authors.lastname: Safdar
authors.forename: Cynthia
authors.initials: C
authors.lastname: Wagner
authors.forename: Colleen
authors.initials: C
authors.lastname: Frayne
authors.forename: David E
authors.initials: DE
authors.lastname: Searls
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
mesh_terms: D000368:Aged; D001900:Boston; D054022:Cerebrum / Q000098:blood supply*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004185:Disability Evaluation; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016896:Treatment Outcome