title: Practice Patterns of Percutaneous Endoscopic Gastrostomy Tube Placement in Acute Stroke: Are the Guidelines Achievable?
abstract: OBJECTIVE
  Our objectives were to evaluate trends in percutaneous endoscopic gastrostomy (PEG) tube placement rate and timing in acute stroke patients. We hypothesized that noncompliance with clinical practice guidelines for timing of tube placement and an increase in placement occurred because of a decrease in length of hospital stay.
  
  
  METHODS
  We conducted a retrospective observational study of archival hospital billing data from the Florida state inpatient healthcare cost and utilization project database from 2001 to 2012 for patients with a primary diagnosis of stroke. Outcome measures were timing of PEG tube placements by year (2006-2012), rate of placements by year (2001-2012), and length of hospital stay. Univariate analyses and simple and multivariable logistic regression analyses were conducted.
  
  
  RESULTS
  The timing of gastrostomy tube placement remained stable with a median of 7 days post admission from 2006 through 2012. The proportion of tubes that were placed at or after 14 days and thereby met the guideline recommendations varied from 14.09% in 2006 to 13.41% in 2012. The rate of tube placement in stroke patients during the acute hospital stay decreased significantly by 25% from 6.94% in 2001 to 5.22% in 2012 (P < .0001). The length of hospital stay for all stroke patients decreased over the study period (P < .0001).
  
  
  CONCLUSIONS
  The vast majority of PEG tube placements happen earlier than clinical practice guidelines recommend. Over the study period, the rate of tubes placed in stroke patients decreased during the acute hospital stay despite an overall reduced length of stay.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Janina
authors.initials: J
authors.lastname: Wilmskoetter
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Annie N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina. Electronic address: bonilhah@musc.edu.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Bonilha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004750:Enteral Nutrition / Q000295:instrumentation / Q000592:standards / Q000639:trends*; D005260:Female; D005431:Florida; D005773:Gastroscopy / Q000592:standards / Q000639:trends*; D005774:Gastrostomy / Q000592:standards / Q000639:trends*; D019983:Guideline Adherence / Q000592:standards / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D017064:Process Assessment, Health Care / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends; D016896:Treatment Outcome
keywords: Stroke; clinical practice pattern; gastrostomy; guideline adherence