Practice Patterns of Percutaneous Endoscopic Gastrostomy Tube Placement in Acute Stroke: Are the Guidelines Achievable?

Wilmskoetter, Janina; Simpson, Annie N.; Simpson, Kit N.; Bonilha, Heather Shaw

doi:10.1016/j.jstrokecerebrovasdis.2016.07.017

Cited by 25 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to findings from other smaller studies, 6 this suggests a mismatch between practice reality and stroke guidelines, which recommend time-limited trials of nasogastric feeding for a period of ≤2 to 3 weeks prior to placing a surgical feeding tube. 7 We found that age was the greatest determinant of early PEG tube placement.…”

Section: Discussionsupporting

confidence: 76%

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

George

Kelly

Albert

et al. 2017

Stroke

View full text Add to dashboard Cite

Background and Purpose-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. Methods-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. Results-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). Conclusions-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.

show abstract

Section: Discussionsupporting

confidence: 76%

Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke

George

Kelly

Albert

et al. 2017

Stroke

View full text Add to dashboard Cite

show abstract

“…Common sequelae of dysphagia are aspiration pneumonia, 1 malnutrition, and dehydration, 2 which can necessitate the placement of a gastrostomy feeding tube, such as a percutaneous endoscopic gastrostomy (PEG) tube. Our research has shown that approximately 5% of all patients hospitalized for stroke receive a PEG tube placement 3 …”

mentioning

confidence: 94%

Factors Associated With Gastrostomy Tube Removal in Patients With Dysphagia After Stroke

Wilmskoetter

Herbert²,

Bonilha

2016

Nut in Clin Prac

Self Cite

View full text Add to dashboard Cite

Gastrostomy feeding tubes are commonly placed in patients with dysphagia after stroke. The subsequent removal of the tube is a primary goal during rehabilitation. The purpose of our review was to identify predictors and factors associated with gastrostomy tube removal in patients with dysphagia after stroke. We conducted a literature review following the PRISMA statement and included the search databases PubMed, Scopus, Web of Science, and CINAHL. Articles were included in the final analysis per predefined inclusion and exclusion criteria. Our search retrieved a total of 853 results consisting of 416 articles (after eliminating duplicates). Six articles met our final eligibility criteria. The following factors were identified in at least 1 article as being significantly associated with gastrostomy tube removal: reduced age, decreased number of comorbidities, prolonged inpatient rehabilitation stay, absence of bilateral stroke, nonhemorrhagic stroke, reduced dysphagia severity, absence of aspiration, absence of premature bolus loss, and timely initiation of pharyngeal swallow. Aspiration was the only factor that was investigated by 2 studies-both using multiple regression and both showing stable results, with absence of aspiration increasing the chances for tube removal. In conclusion, little is known about factors associated with gastrostomy tube removal in patients with dysphagia after stroke. Most of the identified factors are associated with stroke or disease severity; however, the role of the individual factors remains unclear. The strongest predictor appears to be absence of aspiration on modified barium swallow studies emphasizing the importance of instrumental swallow studies in this patient population.

show abstract

“…We found that in total only 1.7% of all stroke patients in our study received a PEG tube during their index hospital stay, compared with 5.22% of stroke patients admitted to community hospitals in Florida during 2012 in a previous study. 4 A higher proportion of hemorrhagic than ischemic stroke patients received a PEG tube (4.5% and 1.2%, respectively). This is consistent with our previous findings.…”

Section: Discussionmentioning

confidence: 98%

“…Patients commonly depend on enteral and/or parenteral nutrition because complications from the stroke impact their ability to meet nutrition and hydration needs, for example, as a consequence of dysphagia (swallowing disorders). When there is an anticipated prolonged need for enteral nutrition, percutaneous endoscopic gastrostomy (PEG) tubes are placed in stroke patients, with about 6% of all stroke patients receiving a PEG tube during their acute inpatient hospital stay …”

Section: Introductionmentioning

confidence: 99%

“…When there is an anticipated prolonged need for enteral nutrition, percutaneous endoscopic gastrostomy (PEG) tubes are placed in stroke patients, 3 with about 6% of all stroke patients receiving a PEG tube during their acute inpatient hospital stay. 4 Despite nutrition and hydration benefits, PEG tubes are associated with short-and long-term complications, such as skin/wound or abdominal wall infections, tube obstruction, and gastric hemorrhage. [5][6][7] Also, PEG tubes are commonly associated with a decrease in quality of life because patients and their families experience the limitations in the patients' ability to eat as an emotional and social burden.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation