title: Current practices in feeding tube placement for US acute ischemic stroke inpatients.
abstract: OBJECTIVE
  We sought to identify current US hospital practices for feeding tube placement in ischemic stroke.
  
  
  METHODS
  In a retrospective observational study, we examined the frequency of feeding tube placement among hospitals in the Nationwide Inpatient Sample with ≥30 adult ischemic stroke admissions annually with length of stay greater than 3 days. We examined trends from 2004 to 2011 and predictors using data from more recent years (2008-2011). We used multilevel multivariable regression models accounting for a hospital random effect, adjusted for patient-level and hospital-level factors to predict feeding tube placement.
  
  
  RESULTS
  Feeding tube insertion rates did not change from 2004 to 2011 (8.1 vs 8.4 per 100 admissions; p trend = 0.11). Among 1,540 hospitals with 164,408 stroke hospitalizations from 2008 to 2011, a feeding tube was placed 8.8% of the time (n = 14,480). Variation in the rate of feeding tube placement was high, from 0% to 26% between hospitals (interquartile range 4.8%-11.2%). In the subset with available race/ethnicity data (n = 88,385), after controlling for patient demographics, socioeconomics, and comorbidities, hospital factors associated with feeding tube placement included stroke volume (odds ratio [OR] 1.28 highest vs lowest quartile; 95% confidence interval [CI] 1.10-1.49), for-profit status (OR 1.13 vs nonprofit; 95% CI 1.01-1.25), and intubation use (OR 1.66 highest vs lowest quartile; 95% CI 1.47-1.87). In addition, hospitals with higher rates of black/Hispanic stroke admissions had increased risk of feeding tube placement (OR 1.28 highest vs lowest quartile; 95% CI 1.14-1.44).
  
  
  CONCLUSIONS
  Variation in feeding tube insertion rates across hospitals is large. Differences across hospitals may be partly explained by external factors beyond the patient-centered decision to insert a feeding tube.
authors.affiliation: From the Department of Neurology (A.G.K., R.G.H.), the University of Rochester School of Medicine and Dentistry (B.P.G.), NY; and the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: George
authors.affiliation: From the Department of Neurology (A.G.K., R.G.H.), the University of Rochester School of Medicine and Dentistry (B.P.G.), NY; and the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Kelly
authors.affiliation: From the Department of Neurology (A.G.K., R.G.H.), the University of Rochester School of Medicine and Dentistry (B.P.G.), NY; and the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: From the Department of Neurology (A.G.K., R.G.H.), the University of Rochester School of Medicine and Dentistry (B.P.G.), NY; and the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S.), Johns Hopkins University School of Medicine, Baltimore, MD. Robert_Holloway@URMC.Rochester.edu.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000628:therapy*; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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