Percutaneous endoscopic gastrostomy tube placement in left versus right middle cerebral artery stroke: effects of laterality.
BACKGROUND
Prolonged dysphagia after middle cerebral artery (MCA) territory strokes may require percutaneous endoscopic gastrostomy (PEG) tube feeding.


OBJECTIVE
We examined the predictors of PEG placement among patients with MCA stroke. It was hypothesized that stroke laterality was a predictor.


METHODS
A retrospective cohort study of existing data from Hartford Hospital Stroke Database was done. A total of 157 patients with acute ischemic MCA stroke were included. Patients were divided into the "PEG" group (n = 24) and "no PEG" group (n = 133). Existing demographic, clinical and swallowing data were compared between the 2 groups.


RESULTS
Demographic data were similar between the groups. The "PEG" group had a higher admission National Institute of Health Stroke Scale (NIHSS) score, higher proportion of patients who had thrombolytic administration, in- hospital aspiration pneumonia and inability to be assessed on first swallow evaluation. Multivariate analysis revealed that all, except thrombolytic administration may predict PEG placement.


CONCLUSIONS
Admission NIHSS score, in-hospital aspiration pneumonia and inability to undergo first swallow evaluation may predict PEG placement in patients with acute MCA stroke. Stroke laterality was not associated. This knowledge facilitates early identification of patients that may require PEG tube placement for early nutrition provision and discharge to rehabilitation.
Department of Neurology Hartford Hospital, Hartford, CT, USA Department of Neurology and Neurosciences, The University of Connecticut Health Center, Hartford, CT, USA.
Christa O'Hana V
CO
San Luis
Ilene
I
Staff
Martin D
MD
Ollenschleger
Gilbert J
GJ
Fortunato
Louise D
LD
McCullough
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
Gastrostomy; dysphagia; endoscopy; functional laterality; middle cerebral artery infarction