Predictors of Recovery of Functional Swallow After Gastrostomy Tube Placement for Dysphagia in Stroke Patients After Inpatient Rehabilitation: A Pilot Study

Abstract

ObjectiveTo determine predictors of early recovery of functional swallow in patients who had gastrostomy (percutaneous endoscopic gastrostomy [PEG]) placement for dysphagia and were discharged to inpatient rehabilitation (IPR) after stroke.MethodsA retrospective study of prospectively identified patients with acute ischemic and hemorrhagic stroke from July 2008 to August 2012 was conducted. Patients who had PEG during stroke admission and were discharged to IPR, were studied. We compared demographics, stroke characteristics, severity of dysphagia, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow.ResultsPatients who remained PEG dependent were significantly older (73 vs. 54 years, p=0.009). Recovery of swallow was more frequent for hemorrhagic stroke patients (80% vs. 47%, p=0.079). Age, adjusting for side of stroke (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.98; p=0.016) and left-sided strokes, adjusting for age (OR, 15.15; 95% CI, 1.32-173.34; p=0.028) were significant predictors of swallow recovery. Patients who recovered swallowing by discharge from IPR were more likely to be discharged home compared to those who remained PEG-dependent (90% vs. 42%, p=0.009).ConclusionYounger age and left-sided stroke may be predictive factors of early recovery of functional swallow in patients who received PEG. Prospective validation is important as avoidance of unnecessary procedures could reduce morbidity and healthcare costs.

Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

“…Positive predictors of recovery of functional swallowing after a stroke are hemorrhagic stroke, younger age, and left-sided stroke. 146 Even during the first 6 months, improvement of swallowing is likely. It is therefore important to repeat assessment of the swallowing function at regular intervals.…”

Nomogram for predicting swallowing recovery in patients after dysphagic stroke

“…20 Crisan et al found that age and side of stroke were significant predictors of swallowing recovery. 21 Despite these previous studies, the prediction of swallowing outcomes remains a difficult task. Recently, Gandolfo et al created a PreDyScore ((modified Rankin Scale, assessing degree of dependence (mRS) + 1/BMI) × 100) to indicate gastrostomy tube placement, 22 and Galovic et al developed and validated a prognostic model for swallowing recovery and enteral tube feeding after ischemic stroke.…”

“…A functional magnetic resonance imaging and diffusion‐weighted imaging study supported a role for increased contralesional somatosensory resources and ipsilesional anterior cerebellum feed‐forward loops for dysphagia recovery 20 . Crisan et al found that age and side of stroke were significant predictors of swallowing recovery 21 . Despite these previous studies, the prediction of swallowing outcomes remains a difficult task.…”

Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: A retrospective cohort study

“…One reason for this is that although contraindications for oral intake and indication criteria for enteral and parenteral nutrition have been formulated, 8 there are no clear indicators for the resumption of oral intake. Although attempts to assess swallowing function and wean patients from feeding tubes following enteral or parenteral nutrition have been reported, 9,10 these have mostly focused on acute 11 or convalescent 12,13 inpatients, and few studies have addressed patients living at home.…”