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Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke

Published online by Cambridge University Press:  23 September 2014

Jian Li ,
Juan Zhang ,
Shujuan Li ,
Hongliang Guo ,
Wei Qin  and
Wen li Hu
Jian Li
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Juan Zhang
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Shujuan Li
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Hongliang Guo
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Wei Qin
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Wen li Hu*
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
*
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Beijing 100020, China. Email: huwenli@sina.com.
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Abstract

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Aims:

the goal of this study was to identify important prognostic variables affecting placement of a percutaneous endoscopic gastrostomy (Peg) tube after acute stroke.

Methods:

We retrospectively reviewed our patient database to identify acute ischemic stroke patients who placed Peg or nasogastric tube (Ngt) tube, but were free of other confounding conditions affecting swallowing. A total of 340 patients were involved in our study. We assessed the influence of age, National Institutes of Health stroke scale (NIHss) score, infarct volume, stroke subtype based on the toAst criteria, swallowing disorders, bilateral lesions in cerebrum and length of stay (los) in a logistic regression analysis.

Results:

In univariate analysis, age (p=0.048), NIHss score (p<0.0001), lesion volume (p<0.0001), los (p<0.0001), stroke location (p=0.045), and swallowing disorders (p<0.0001) were found to be the primary predictors of placing Peg. the presence of lesions in bilateral cerebral was included in the final model based on clinical considerations. After multivariate adjustment, only NIHss score (odds ratio [oR], 4.055; 95% confidence interval [CI], 2.398-6.857; p=0.0001), lesion volume (oR, 1.69; 95%CI, 1.09–4.39; p=0.014), swallowing disorders (oR, 1.151; 95% CI, 1.02-1.294; p=0.047), los (oR, 0.955; 95% CI, 0.914-0.998; p=0.0415) and bilateral lesions (oR, 2.8; 95% CI, 1.666-4.705; p=0.0001) remained significant.

Conclusion:

our data shows that NIHss score, lesion volume, swallowing disorders, los and bilateral lesions in cerebrum can predict the requiring of Peg tube insertion in patients after stroke.

Résumé

RÉSUMÉ

Facteurs de prédiction de la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral.

Objectifs:

Le but de cette étude était d'identifier les variables importantes du pronostic influençant la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral aigu.

Méthode:

Nous avons revu rétrospectivement notre base de données pour identifier les patients atteints d'un AVC ischémique aigu, chez qui un tube nasogastrique ou un tube de gastrostomie par endoscopie percutanée avait été mis en place, mais qui ne présentaient pas d'autres problèmes touchant la déglutition. Notre étude porte sur 340 patients. Nous avons étudié au moyen d'une analyse de régression logistique l'influence de l'âge, le score au National Institutes of Health Stroke Scale (NIHSS), le volume de l'infarctus, le sous-type d'AVC selon les critères TOAST, les problèmes de déglutition, les lésions bilatérales au niveau des hémisphères cérébraux et le temps d'hospitalisation (TH).

Résultats:

À l'analyse univariée, l'âge (p = 0,048), le score au NIHSS (p < 0,0001), le volume de la lésion (p < 0,0001), le TH (p < 0,0001), l'endroit de l'AVC (p = 0,045) et les troubles de la déglutition (p < 0,0001) étaient les principaux facteurs de prédiction de la mise en place d'un tube de gastrostomie. La présence de lésions cérébrales bilatérales était incluse dans le modèle fmal pour des raisons cliniques. Après ajustement multivarié, seuls le score NIHSS (rapport de cotes [RC] 4,055 ; intervalle de confiance [ICI à 95% de 2,398 à 6,857 ; p = 0,0001), le volume de la lésion (RC 1,69 ; IC à 95% de 1,09 à 4,39 ; p = 0,014), les troubles de la déglutition (RC 1,151 ; IC à 95% de 1,02 à 1,294 ; p = 0,047), le TH (RC 0,955 ; IC à 95% de 0,914 à 0,998 ; p = 0,0415) et les lésions bilatérales (RC 2,8 ; IC à 95% de 1,666 à 4,705 ; p = 0,0001 demeuraient significatifs.

Conclusion:

Nos données démontrent que le score au NIHSS, le volume de la lésion, les troubles de la déglutition, le TH et la présence de lésions bilatérales dans les hémisphères cérébraux peuvent prédire la nécessité de mettre en place un tube de gastrostomie par endoscopie percutanée chez les patients atteints d'un AVC.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 1 , January 2014 , pp. 24 - 28
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1. Haywood, S. PEG feeding tube placement and aftercare. Nurs Times. 2012;108:20–2.Google ScholarPubMed
2. Potack, JZ, Chokhavatia, S. Complications of and controversies associated with percutaneous endoscopic gastrostomy: report of a case and literature review. Medscape J Med. 2008;10:142.Google Scholar
3. Alshekhlee, A, Ranawat, N, Syed, TU, Conway, D, Ahmad, SA, Zaidat, OO. National Institutes of Health Stroke Scale assists in predicting the need for percutaneous endoscopic gastrostomy tube placement in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19:347–52.Google Scholar
4. Dennis, MS, Lewis, SC, Warlow, C, et al. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial. Lancet. 2005;365:764–72.Google ScholarPubMed
5. Panos, MZ, Reilly, H, Moran, A, et al. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. Gut. 1994;35:1551–6.Google Scholar
6. Gomes, CAR Jr, Lustosa, SAS, Matos, D, Andriolo, RB, Waisberg, DR, Waisberg, J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database of Systematic Reviews 2012, Issue 3.Google Scholar
7. Dwolatzky, T, Berezovski, S, Friedmann, R, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr. 2001;20:535–40.Google Scholar
8. John, B, Jesper, L, Lena, M, et al. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroentero. 2012;47:737–42.Google Scholar
9. Somi, MH, Maghbouli, L, Antikchi, M. Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life. Turk J Gastroenterol. 2011;22:128–33.Google Scholar
10. Dwolatzky, T, Berezovski, S, Friedmann, R, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr. 2001;20:535–40.CrossRefGoogle ScholarPubMed
11. Norton, B, Homer-Ward, M, Donnelly, MT, Long, RG, Holmes, GK. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ. 1996;312:13–6.Google Scholar
12. Hilker, R, Poetter, C, Findeisen, N, et al. Nosocomial pneumonia after acute stroke: Implications for neurological intensive care medicine. Stroke. 2003;34:975–81.Google Scholar
13. El Solh, A, Okada, M, Bhat, A, Pietrantoni, C. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Med. 2003;29:1451–5.CrossRefGoogle ScholarPubMed
14. Kumar, S, Langmore, S, Goddeau, RP Jr, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis. 2012;21:114–20.Google Scholar
15. Bates, B, Choi, JY, Duncan, PW, et al. Veterans Affairs/Department of Defense clinical practice guideline for the management of adult stroke rehabilitation care: Executive summary. Stroke. 2005;36: 2049–56.Google Scholar
16. Martin, RE, Goodyear, BG, Gati, JS, Menon, RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85:938–50.CrossRefGoogle ScholarPubMed
17. Ertekin, C, Aydogdu, I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114:2226–44.CrossRefGoogle ScholarPubMed
18. Reisberg, B, Ferris, SH, Georgotas, A, et al. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139:1136–9.Google Scholar
19. Sims, JR, Gharai, LR, Schaefer, PW, et al. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology. 2009;72:2104–10.Google Scholar
20. Pedraza, S, Puig, J, Blasco, G. Reliability of the ABC/2 method in determining acute infarct volume. J Neuroimaging. 2012;22:155–9.CrossRefGoogle ScholarPubMed
21. Hamdy, S, Aziz, Q, Rothwell, JC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke Lancet. 1997;350:686–92.Google Scholar
22. Osawa, A, Maeshima, S, Matsuda, H, Tanahashi, N. Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography. Neuroradiology. 2013;55:413–21.Google Scholar
23. Baba, Y, Teramoto, S, Hasegawa, H, Machida, A, Akishita, M, Toba, K. Characteristics and limitation of portable bedside swallowing test in elderly with dementia: comparison between the repetitive saliva swallowing test and the simple swallowing provocation test. Nihon Ronen Igakkai Zasshi. 2005;42:323–7.Google Scholar
24. Osawa, A, Maeshima, S, Tanahashi, N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35:276–81.Google Scholar
25. Hamdy, S, Aziz, Q, Rothwell, JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115:1104–12.CrossRefGoogle ScholarPubMed
26. Johnston, KC, Wagner, DP, Wang, XQ, et al. Validation of an acute ischemic stroke model: Does diffusion-weighted imaging lesion volume offer a clinically significant improvement in prediction of outcome? Stroke. 2007;38:1820–5.Google Scholar
27. Daniels, SK, Foundas, AL. Lesion localization in acute stroke patients with risk of aspiration. Neuroimaging. 1999;9:91–8.Google Scholar
28. Turhan, N, Atalay, A, Muderrisoglu, H. Predictors of functional outcome in first-ever ischemic stroke: A special interest to ischemic subtypes, comorbidity and age. NeuroRehabilitation. 2006;24:321–6.Google Scholar
29. Thijs, VN, Lansberg, MG, Beaulieu, C, et al. Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke. 2000;31:2597–602.Google Scholar
30. Lindsell, CJ, Alwell, K, Moomaw, CJ, et al. Validity of a retro spective National Institutes of Health Stroke Scale scoring methodology in patients with severe stroke. J Stroke Cerebrovasc Dis. 2005;14:281–3.Google Scholar