title: In-Hospital Mortality with Use of Percutaneous Endoscopic Gastrostomy in Traumatic Brain Injury Patients: Results of a Nationwide Population-Based Study.
abstract: Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive procedure that has been associated with high short-term mortality. Its use of special interest in traumatic brain injury (TBI) patients as nutrition support constitutes important issues in intensive care of this group. We used a national database to determine the incidence of, and factors associated with, in-hospital mortality among TBI patients undergoing PEG.
  
  
  
  We conducted a retrospective study using the US nationwide inpatient sample to analyze data from all hospitalizations in 2008 with International Classification of Diseases, Ninth Revision, diagnostic and procedure codes identifying patients with TBI and hemorrhagic stroke who received PEG. Bivariate and multivariate logistic regression analyses were performed using demographic and clinical variables to identify predictors of in-hospital mortality in this patient population. Patients who did not undergo PEG were used as control.
  
  
  
  In-hospital mortality after PEG was 6% (95% CI, 0.05-0.76%) among the TBI population with 0.2% occurring in the first 7 days and 2% occurring in the first 14 days. These patients had a higher incidence of other trauma-related comorbidities and were classified as high-risk stratification based on SRRi score compared to the non-PEG group. Factors strongly predictive of in-hospital mortality were age >51 years, not receiving a PEG, and having a high comorbidity burden of >2.
  
  
  
  Understanding the rate of mortality associated with PEG in this patient population and identifying factors that increase and decrease the risk of death will improve patient selection for those most likely to benefit from this procedure.
authors.affiliation: Department of Anesthesiology, McGovern Medical School, University of Texas at Houston, 6431 Fannin, MSB 5.020, Houston, TX, 77030, USA.
authors.forename: Rabail
authors.initials: R
authors.lastname: Chaudhry
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, MA, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Batra
authors.affiliation: Department of Anesthesiology, McGovern Medical School, University of Texas at Houston, 6431 Fannin, MSB 5.020, Houston, TX, 77030, USA.
authors.forename: Omar L
authors.initials: OL
authors.lastname: Mancillas
authors.affiliation: Department of Anesthesiology, McGovern Medical School, University of Texas at Houston, 6431 Fannin, MSB 5.020, Houston, TX, 77030, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wegner
authors.affiliation: Department of Anesthesiology, McGovern Medical School, University of Texas at Houston, 6431 Fannin, MSB 5.020, Houston, TX, 77030, USA.
authors.forename: Navneet
authors.initials: N
authors.lastname: Grewal
authors.affiliation: Department of Anesthesiology and Neurosurgery, McGovern Medical School, University of Texas at Houston, 6431 Fannin, MSB 5.020, Houston, TX, 77030, USA. George.W.Williams@uth.tmc.edu.
authors.forename: George W
authors.identifier: 0000-0001-9079-610X
authors.initials: GW
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: In-hospital mortality; Nutrition; PEG; Patient outcomes; Percutaneous endoscopic gastrostomy; Traumatic brain injury