title: Predictive factors for percutaneous endoscopic gastrostomy in patients with spontaneous intracranial hemorrhage.
abstract: BACKGROUND
  Dysphagia is frequent after hemorrhagic stroke, and some of the affected patients require prolonged enteral nutrition, most often via percutaneous endoscopic gastrostomy (PEG) tubes. The identification of patients at risk of prolonged dysphagia permits earlier tube placement and helps guide clinicians in the decision-making process.
  
  
  METHODS
  This retrospective study included all patients with spontaneous ICH admitted to a tertiary university hospital from 2007 until 2009 (n = 208). Fifty-one patients received PEG tubes. PEG tube placement was conducted in ventilated patients within 30 days and in spontaneously breathing patients if swallowing did not improve within 14 days.
  
  
  RESULTS
  Twenty-five percent of patients received PEG tubes. Those patients had larger lobar hemorrhages, intraventricular hemorrhage and occlusive hydrocephalus and higher ICH scores. Furthermore, patients with PEG scored worse on Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS) and Acute Physiology And Chronic Health Evaluation (APACHE II), more frequently needed mechanical ventilation, and had more inflammatory and renal complications. A multivariate regression analysis identified GCS, occlusive hydrocephalus, mechanical ventilation, and systemic sepsis as independent risk factors for PEG tube placement.
  
  
  CONCLUSIONS
  Disease severity and neurocritical care complications represent the major influencing parameters for PEG tube placement in spontaneous ICH patients.
authors.affiliation: Department of Neurology, University of Erlangen, Schwabachanlage 6, Erlangen, Germany. ines-christine.kiphuth@uk-erlangen.de
authors.forename: Ines C
authors.initials: IC
authors.lastname: Kiphuth
authors.forename: Joji B
authors.initials: JB
authors.lastname: Kuramatsu
authors.forename: Hannes
authors.initials: H
authors.lastname: Lücking
authors.forename: Stephan
authors.initials: S
authors.lastname: Kloska
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005774:Gastrostomy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology