title: Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study.
abstract: BACKGROUND
  Oropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay.
  
  
  OBJECTIVE
  The overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m(2), eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay.
  
  
  METHODS
  The study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period.
  
  
  RESULTS
  Mean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018).
  
  
  CONCLUSIONS
  Essential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; gunnel.warn.hede@ki.se.
authors.forename: Gunnel Wärn
authors.initials: GW
authors.lastname: Hede
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gerd
authors.initials: G
authors.lastname: Faxén-Irving
authors.affiliation: Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ann Ödlund
authors.initials: AÖ
authors.lastname: Olin
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Ebbeskog
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; milita.crisby@ki.se.
authors.forename: Milita
authors.initials: M
authors.lastname: Crisby
keywords: nutritional assessment; oropharyngeal dysphagia; percutaneous endoscopic gastrostomy; post-procedural complications; stroke