title: Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke: An Observational Study From the US Nationwide Inpatient Sample.
abstract: Stroke guidelines recommend time-limited trials of nasogastric feeding prior to percutaneous endoscopic gastrostomy (PEG) tube placement. We sought to describe timing of PEG placement and identify factors associated with early PEG for acute ischemic stroke.
  
  
  
  We designed a retrospective observational study to examine time to PEG for ischemic stroke admissions in the Nationwide Inpatient Sample, 2001 to 2011. We defined early PEG placement as 1 to 7 days from admission. Using multivariable regression analysis, we identified the effects of patient and hospital characteristics on PEG timing.
  
  
  
  We identified 34 623 admissions receiving a PEG from 2001 to 2011, 53% of which received the PEG 1 to 7 days from admission. Among hospitals placing ≥10 PEG tubes, median time to PEG for individual hospitals ranged from 3 days to over 3 weeks (interquartile range 6-8.5 days). Older adult age groups were associated with early PEG (≥85 years versus 18-54 years: adjusted odds ratio 1.68, 95% confidence interval 1.50-1.87). Those receiving a PEG and tracheostomy were more likely to receive the PEG beyond 7 days, and these patients were more often younger compared with PEG only recipients. Those admitted to high-volume hospitals were more likely to receive their PEG early (≥350 versus <150 hospitalizations; adjusted odds ratio 1.26, 95% confidence interval 1.17-1.35).
  
  
  
  More than half of the PEG recipients received their surgical feeding tube within 7 days of admission. The oldest old, who may benefit most from time-limited trials of nasogastric feeding for ≥2 to 3 weeks, were most likely to receive a PEG within 7 days.
authors.affiliation: From the Department of Neurology, University of Rochester Medical Center, NY (B.P.G., A.G.K., R.G.H.); College of Arts and Science, University of Rochester, NY (G.P.A.); and Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT (D.Y.H.).
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: George
authors.affiliation: From the Department of Neurology, University of Rochester Medical Center, NY (B.P.G., A.G.K., R.G.H.); College of Arts and Science, University of Rochester, NY (G.P.A.); and Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT (D.Y.H.).
authors.forename: Adam G
authors.initials: AG
authors.lastname: Kelly
authors.affiliation: From the Department of Neurology, University of Rochester Medical Center, NY (B.P.G., A.G.K., R.G.H.); College of Arts and Science, University of Rochester, NY (G.P.A.); and Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT (D.Y.H.).
authors.forename: George P
authors.initials: GP
authors.lastname: Albert
authors.affiliation: From the Department of Neurology, University of Rochester Medical Center, NY (B.P.G., A.G.K., R.G.H.); College of Arts and Science, University of Rochester, NY (G.P.A.); and Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT (D.Y.H.).
authors.forename: David Y
authors.initials: DY
authors.lastname: Hwang
authors.affiliation: From the Department of Neurology, University of Rochester Medical Center, NY (B.P.G., A.G.K., R.G.H.); College of Arts and Science, University of Rochester, NY (G.P.A.); and Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT (D.Y.H.). 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 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: PEG; feeding tube; gastrostomy tube; ischemic stroke; variation