Document Detail

Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction.
MedLine Citation:
PMID:  20851628     Owner:  NLM     Status:  MEDLINE    
This study investigated the influence of age, National Institutes of Health Stroke Scale (NIHSS) score, time from stroke onset, infarct location and volume in predicting placement of a percutaneous endoscopic gastrostomy (PEG) tube in patients with severe dysphagia from an acute-subacute hemispheric infarction. We performed a retrospective analysis of a hospital-based patient cohort to analyze the effect of the aforementioned variables on the decision of whether or not to place a PEG tube. Consecutive patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for acute ischemic stroke, Current Procedural Terminology (CPT)-4 codes for a formal swallowing evaluation by a speech pathologist, and procedure codes for PEG placement over a 5-year period from existing medical records at our institution. Only patients with severe dysphagia were enrolled. A total of 77 patients met inclusion criteria; 20 of them underwent PEG placement. The relationship between age (dichotomized; < and ≥75 years), time from stroke onset (days), NIHSS score, acute infarct lesion volume (dichotomized; < and ≥100 cc), and infarct location (ie, insula, anterior insula, periventricular white matter, inferior frontal gyrus, motor cortex, or bilateral hemispheres) with PEG tube placement were analyzed using logistic regression analysis. In univariate analysis, NIHSS score (P = .005), lesion volume (P = .022), and presence of bihemispheric infarction (P = .005) were found to be the main predictors of interest. After multivariate adjustment, only NIHSS score (odds ratio [OR], 1.15; 90% confidence interval [CI], 1.02-1.29; P = .04) and presence of bihemispheric infarcts (OR, 4.67; 90% CI, 1.58-13.75; P = .018) remained significant. Our data indicates that baseline NIHSS score and the presence of bihemispheric infarcts predict PEG placement during hospitalization from an acute-subacute hemispheric infarction in patients with severe dysphagia. These results require further validation in future studies.
Sandeep Kumar; Susan Langmore; Richard P Goddeau; Adel Alhazzani; Magdy Selim; Louis R Caplan; Lin Zhu; Adnan Safdar; Cynthia Wagner; Colleen Frayne; David E Searls; Gottfried Schlaug
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-09-19
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  21     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-30     Completed Date:  2012-05-24     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  114-20     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cerebrum / blood supply*
Deglutition Disorders / diagnosis,  etiology,  physiopathology,  surgery*
Disability Evaluation
Endoscopy, Gastrointestinal / instrumentation*
Enteral Nutrition / instrumentation*
Gastrostomy / instrumentation*
Logistic Models
Magnetic Resonance Imaging
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke / complications*,  diagnosis,  physiopathology
Treatment Outcome
Grant Support
1R01-DC008796/DC/NIDCD NIH HHS; 1R01-NS045049/NS/NINDS NIH HHS; 1R01-NS045754-01A2/NS/NINDS NIH HHS; 1R01-NS057127/NS/NINDS NIH HHS; 1R01-NS057127-01A1/NS/NINDS NIH HHS; 3R01-DC008796-02S1/DC/NIDCD NIH HHS; 5R01-CA120950-02/CA/NCI NIH HHS; 5R01-HL46690-14/HL/NHLBI NIH HHS; 5UO1-NS044876-03/NS/NINDS NIH HHS; R01 CA120950/CA/NCI NIH HHS; R01 CA120950-05/CA/NCI NIH HHS; R01-DC009823-01/DC/NIDCD NIH HHS

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