Current practices in feeding tube placement for US acute ischemic stroke inpatients

George, Benjamin P.; Kelly, Adam G.; Schneider, Eric B.; Holloway, Robert G.

doi:10.1212/wnl.0000000000000764

Cited by 62 publications

(39 citation statements)

References 36 publications

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“…However, in our study length of stay was longer for minority patients compared to whites (median 12 vs 8 days), precluding the possibility that white patients were given more time to recover swallowing function during their hospitalization. Our findings are consistent with a recent study describing racial disparities in PEG placement after ischemic stroke 26 ; however, some of the observed disparities may at least in part be due to residual confounding by education level, another commonly employed surrogate of SES. Since the NIS does not collect information on level of education, we were unable to further test this hypothesis in our dataset.…”

Section: Discussionsupporting

confidence: 91%

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Faigle

Bahouth

Urrutia

et al. 2016

Stroke

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Background and Purpose Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding of patients after intracerebral hemorrhage (ICH). We sought to determine whether PEG placement after ICH differs by race and socioeconomic status. Methods Patient discharges with ICH as the primary diagnosis from 2007 to 2011 were queried from the Nationwide Inpatient Sample. Logistic regression was used to evaluate the association between race, insurance status, and household income with PEG placement. Results Of 49,946 included ICH admissions, a PEG was placed in 4,464 (8.94%). Among PEG recipients, 47.2% were minorities and 15.6% were Medicaid enrollees, while 33.7% and 8.2% of patients without a PEG were of a race other than white and enrolled in Medicaid, respectively (P<0.001). Compared to whites, the odds of PEG were highest among Asians/Pacific Islanders (OR 1.62, 95% CI 1.32-1.99) and blacks (OR 1.42, 95%, CI 1.28-1.59). Low household income (OR 1.25, 95% CI 1.09-1.44 in lowest compared to highest quartile) and enrollment in Medicaid (OR 1.36, 95% CI 1.17-1.59 compared to private insurance) were associated with PEG placement. Racial disparities (minorities versus whites) were most pronounced in small/medium-sized hospitals (OR 1.77, 95% CI 1.43-2.20 vs. OR 1.31, 95% CI 1.17-1.47 in large hospitals; p-value for interaction 0.011), and in hospitals with low ICH case volume (OR 1.58, 95% CI 1.38-1.81 vs. OR 1.29, 95% CI 1.12-1.50 in hospitals with high ICH case volume; p-value for interaction 0.007). Conclusion Minority race, Medicaid enrollment, and low household income are associated with PEG placement after ICH.

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Section: Discussionsupporting

confidence: 91%

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Faigle

Bahouth

Urrutia

et al. 2016

Stroke

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“…This finding is in part contradictory to previous findings that black and Hispanic ischemic stroke patients have higher risks for PEG tube placements than white patients. 17 In our study, patients with and without PEG tube placements showed significant differences in race distribution based on univariate analyses. However, after adjusting for treatment, provider and environment characteristics, race was not significant for 30-day readmissions.…”

Section: Discussionmentioning

confidence: 53%

Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes

Wilmskoetter

Simpson

Bonilha

2016

Journal of Stroke and Cerebrovascular Diseases

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Objectives A critical mission of acute care hospitals is to reduce hospital readmissions to improve patient care and avoid monetary penalties. We speculated that stroke patients with enteral tube feeding are high-risk patients and sought to evaluate their hospital readmissions. Methods We analyzed archival hospital billing data from stroke patients discharged from acute care hospitals in Florida in 2012 for 30- and 60-day readmission rates, 30-day readmission rates by discharge destination, most frequent primary readmission diagnoses, and predictors of 30-day readmissions. We conducted univariate and multivariable logistic regression analyses. Results We analyzed 26,774 discharge records. Within 30 days after discharge, 21.06% (N = 299) of stroke patients with percutaneous endoscopic gastrostomy (PEG) tube placement were rehospitalized. Of those readmissions, 11.71% (N = 35) were preventable. Among stroke patients with a PEG tube placement, 53.80% were discharged to skilled nursing facilities and 27.88% were rehospitalized within 30 days. Septicemia was the most frequent primary readmission diagnosis. Comorbidities, stroke type, length of hospital stay, and discharge destinations were predictive for 30-day readmissions (area under the receiver operating characteristic curve was .81). Conclusions Stroke patients with a PEG tube placement during their index hospital stay are twice as likely to be readmitted within 30 days compared to stroke patients without PEG tube placements. The primary readmission diagnosis for some patients was directly linked to PEG tube complications. We have identified risk factors that can be used to focus resources for readmission prevention.

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“…In a recent study by George et al examining feeding tube placement in ischemic stroke patients, the authors suggest that a decision aid to deliver evidence-based options and inform families/patients about outcomes in dysphagia after stroke would greatly improve care. 73 Development of decision aids for common neurocritical care situations will have a large impact on improving the quality of shared decision making and potentially reducing conflict in the NICU.…”

Section: Shared Decision Making With Surrogatesmentioning

confidence: 99%

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

et al. 2015

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In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed. We outline the process of reaching a shared decision between family and care team and describe a practice for conducting optimum family meetings based on studies of ICU families in crisis. We review challenges in the decision making process between surrogate decision makers and medical teams in neurocritical care settings, as well as methods to ameliorate conflicts. Ultimately, the goal of shared decision making is to increase knowledge amongst surrogates and care providers, decrease decisional conflict, promote realistic expectations and preference-centered treatment strategies, and lift the emotional burden on families of neurocritical care patients.

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Current practices in feeding tube placement for US acute ischemic stroke inpatients

Abstract: Objective: We sought to identify current US hospital practices for feeding tube placement in ischemic stroke.

Cited by 62 publications

References 36 publications

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States

Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

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