Click
here to close Hello! We notice that
you are using Internet Explorer, which is not supported by Echinobase
and may cause the site to display incorrectly. We suggest using a
current version of Chrome,
FireFox,
or Safari.
Neurology
2018 Feb 13;907:e544-e552. doi: 10.1212/WNL.0000000000004962.
Show Gene links
Show Anatomy links
Outcomes among patients with direct enteral vs nasogastric tube placement after acute stroke.
Joundi RA
,
Saposnik G
,
Martino R
,
Fang J
,
Porter J
,
Kapral MK
.
???displayArticle.abstract???
OBJECTIVE: To compare complications, disability, and long-term mortality of patients who received direct enteral tube vs nasogastric tube feeding alone after acute stroke.
METHODS: We used the Ontario Stroke Registry to identify patients who received direct enteral tubes (DET; gastrostomy or jejunostomy) or temporary nasogastric tubes (NGT) alone during hospital stay after acute ischemic stroke or intracerebral hemorrhage from July 1, 2003, to March 31, 2013. We used propensity matching to compare groups from discharge and evaluated discharge disability, institutionalization, complications, and mortality, with follow-up over 2 years, and with cumulative incidence functions used to account for competing risks.
RESULTS: Among 1,448 patients with DET placement who survived until discharge, 1,421 were successfully matched to patients with NGT alone. Patients with DET had reduced risk of death within 30 days after discharge (9.7% vs 15.3%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.49-0.75), but this difference was eliminated after matching on length of stay and discharge disability (HR 0.90, 95% CI 0.70-1.17). Patients with DET had higher rates of severe disability at discharge (modified Rankin Scale score 4-5; 89.6% vs 78.4%), discharge to long-term care (38.0% vs 16.1%), aspiration pneumonia (14.4% vs 5.1%) and other complications, and mortality at 2 years (41.1% vs 35.9%).
CONCLUSIONS: Patients with DET placement after acute stroke have more severe disability at discharge compared to those with NGT placement alone, and associated higher rates of institutionalization, medical complications, and long-term mortality. These findings may inform goals of care discussions and decisions regarding long-term tube feeding after acute stroke.
Austin,
A comparison of 12 algorithms for matching on the propensity score.
2014, Pubmed
Austin,
A comparison of 12 algorithms for matching on the propensity score.
2014,
Pubmed
Bushnell,
Retrospective assessment of initial stroke severity: comparison of the NIH Stroke Scale and the Canadian Neurological Scale.
2001,
Pubmed
Cadilhac,
National stroke registries for monitoring and improving the quality of hospital care: A systematic review.
2016,
Pubmed
Callahan,
Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting.
1999,
Pubmed
Charlson,
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
1987,
Pubmed
Cummins,
An assessment of the Nam Pehchan computer program for the identification of names of south Asian ethnic origin.
1999,
Pubmed
Côté,
The Canadian Neurological Scale: validation and reliability assessment.
1989,
Pubmed
Dennis,
Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial.
2005,
Pubmed
Geeganage,
Interventions for dysphagia and nutritional support in acute and subacute stroke.
2012,
Pubmed
George,
Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke: An Observational Study From the US Nationwide Inpatient Sample.
2017,
Pubmed
George,
Current practices in feeding tube placement for US acute ischemic stroke inpatients.
2014,
Pubmed
Gomes,
Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances.
2015,
Pubmed
Gomes,
Royal College of Physicians Intercollegiate Stroke Working Party evidence-based guidelines for the nutritional support of patients who have had a stroke.
2014,
Pubmed
Hebert,
Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015.
2016,
Pubmed
Itkin,
Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
2011,
Pubmed
Jauch,
Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
2013,
Pubmed
Joundi,
Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.
2017,
Pubmed
,
Echinobase
Kapral,
Neighborhood income and stroke care and outcomes.
2012,
Pubmed
,
Echinobase
Martino,
Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.
2005,
Pubmed
Perry,
Screening for dysphagia and aspiration in acute stroke: a systematic review.
2001,
Pubmed
Quan,
Development and validation of a surname list to define Chinese ethnicity.
2006,
Pubmed
Rickman,
Percutaneous endoscopic gastrostomy: psychological effects.
1999,
Pubmed
Rubin,
States Worse Than Death Among Hospitalized Patients With Serious Illnesses.
2016,
Pubmed
Saposnik,
IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke.
2011,
Pubmed
Saposnik,
Escalating levels of access to in-hospital care and stroke mortality.
2008,
Pubmed
Stavem,
Reliability and validity of the Canadian Neurological Scale in retrospective assessment of initial stroke severity.
2003,
Pubmed
Stroud,
Guidelines for enteral feeding in adult hospital patients.
2003,
Pubmed
Suissa,
Immortal time bias in pharmaco-epidemiology.
2008,
Pubmed
Tippett,
Clinical challenges in the evaluation and treatment of individuals with poststroke dysphagia.
2011,
Pubmed
Wijdicks,
Percutaneous endoscopic gastrostomy after acute stroke: complications and outcome.
1999,
Pubmed
Wilmskoetter,
Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes.
2016,
Pubmed
Wilmskoetter,
Practice Patterns of Percutaneous Endoscopic Gastrostomy Tube Placement in Acute Stroke: Are the Guidelines Achievable?
2016,
Pubmed
Wirth,
Guideline clinical nutrition in patients with stroke.
2013,
Pubmed