title: Novel score predicting gastrostomy tube placement in intracerebral hemorrhage.
abstract: OBJECTIVE
  Dysphagia after intracerebral hemorrhage (ICH) contributes significantly to morbidity, often necessitating placement of a percutaneous endoscopic gastrostomy (PEG) tube. This study describes a novel risk prediction score for PEG placement after ICH.
  
  
  METHODS
  We retrospectively analyzed data from 234 patients with ICH presenting during a 4-year period. One hundred eighty-nine patients met inclusion criteria. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting predictors of PEG placement based on strength of association.
  
  
  RESULTS
  Age (odds ratio [OR], 1.64 per 10-year increase in age; 95% confidence interval [CI], 1.02-2.65), black race (OR, 3.26; 95% CI, 0.96-11.05), Glasgow Coma Scale (OR, 0.80; 95% CI, 0.62-1.03), and ICH volume (OR, 1.38 per 10-mL increase in ICH volume) were independent predictors of PEG placement. The final model for score development achieved an area under the curve of 0.7911 (95% CI, 0.6931-0.8892) in the validation group. The score was named the GRAVo score: Glasgow Coma Scale ≤12 (2 points), Race (1 point for black), Age >50 years (2 points), and ICH Volume >30 mL (1 point). A score >4 was associated with ≈12× higher odds of PEG placement when compared with a score ≤4 (OR, 11.81; 95% CI, 5.04-27.66), predicting PEG placement with 46.55% sensitivity and 93.13% specificity.
  
  
  CONCLUSIONS
  The GRAVo score, combining information about Glasgow Coma Scale, race, age, and ICH volume, may be a useful predictor of PEG placement in ICH patients.
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. rfaigle1@jhmi.edu.
authors.forename: Roland
authors.initials: R
authors.lastname: Faigle
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Marsh
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rafael H
authors.initials: RH
authors.lastname: Llinas
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Urrutia
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology*; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D055815:Young Adult
keywords: cerebral hemorrhage; enteral nutrition; stroke; tube feeding