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Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement after Stroke

Published online by Cambridge University Press:  23 September 2014

Jian Li ,
Juan Zhang ,
Shujuan Li ,
Hongliang Guo ,
Wei Qin  and
Wen li Hu
Jian Li
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Juan Zhang
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Shujuan Li
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Hongliang Guo
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Wei Qin
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Wen li Hu*
Affiliation:
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
*
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Beijing 100020, China. Email: [email protected].
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Abstract

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Aims:

the goal of this study was to identify important prognostic variables affecting placement of a percutaneous endoscopic gastrostomy (Peg) tube after acute stroke.

Methods:

We retrospectively reviewed our patient database to identify acute ischemic stroke patients who placed Peg or nasogastric tube (Ngt) tube, but were free of other confounding conditions affecting swallowing. A total of 340 patients were involved in our study. We assessed the influence of age, National Institutes of Health stroke scale (NIHss) score, infarct volume, stroke subtype based on the toAst criteria, swallowing disorders, bilateral lesions in cerebrum and length of stay (los) in a logistic regression analysis.

Results:

In univariate analysis, age (p=0.048), NIHss score (p<0.0001), lesion volume (p<0.0001), los (p<0.0001), stroke location (p=0.045), and swallowing disorders (p<0.0001) were found to be the primary predictors of placing Peg. the presence of lesions in bilateral cerebral was included in the final model based on clinical considerations. After multivariate adjustment, only NIHss score (odds ratio [oR], 4.055; 95% confidence interval [CI], 2.398-6.857; p=0.0001), lesion volume (oR, 1.69; 95%CI, 1.09–4.39; p=0.014), swallowing disorders (oR, 1.151; 95% CI, 1.02-1.294; p=0.047), los (oR, 0.955; 95% CI, 0.914-0.998; p=0.0415) and bilateral lesions (oR, 2.8; 95% CI, 1.666-4.705; p=0.0001) remained significant.

Conclusion:

our data shows that NIHss score, lesion volume, swallowing disorders, los and bilateral lesions in cerebrum can predict the requiring of Peg tube insertion in patients after stroke.

Résumé

RÉSUMÉ

Facteurs de prédiction de la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral.

Objectifs:

Le but de cette étude était d'identifier les variables importantes du pronostic influençant la mise en place d'un tube de gastrostomie par endoscopie percutanée après un accident vasculaire cérébral aigu.

Méthode:

Nous avons revu rétrospectivement notre base de données pour identifier les patients atteints d'un AVC ischémique aigu, chez qui un tube nasogastrique ou un tube de gastrostomie par endoscopie percutanée avait été mis en place, mais qui ne présentaient pas d'autres problèmes touchant la déglutition. Notre étude porte sur 340 patients. Nous avons étudié au moyen d'une analyse de régression logistique l'influence de l'âge, le score au National Institutes of Health Stroke Scale (NIHSS), le volume de l'infarctus, le sous-type d'AVC selon les critères TOAST, les problèmes de déglutition, les lésions bilatérales au niveau des hémisphères cérébraux et le temps d'hospitalisation (TH).

Résultats:

À l'analyse univariée, l'âge (p = 0,048), le score au NIHSS (p < 0,0001), le volume de la lésion (p < 0,0001), le TH (p < 0,0001), l'endroit de l'AVC (p = 0,045) et les troubles de la déglutition (p < 0,0001) étaient les principaux facteurs de prédiction de la mise en place d'un tube de gastrostomie. La présence de lésions cérébrales bilatérales était incluse dans le modèle fmal pour des raisons cliniques. Après ajustement multivarié, seuls le score NIHSS (rapport de cotes [RC] 4,055 ; intervalle de confiance [ICI à 95% de 2,398 à 6,857 ; p = 0,0001), le volume de la lésion (RC 1,69 ; IC à 95% de 1,09 à 4,39 ; p = 0,014), les troubles de la déglutition (RC 1,151 ; IC à 95% de 1,02 à 1,294 ; p = 0,047), le TH (RC 0,955 ; IC à 95% de 0,914 à 0,998 ; p = 0,0415) et les lésions bilatérales (RC 2,8 ; IC à 95% de 1,666 à 4,705 ; p = 0,0001 demeuraient significatifs.

Conclusion:

Nos données démontrent que le score au NIHSS, le volume de la lésion, les troubles de la déglutition, le TH et la présence de lésions bilatérales dans les hémisphères cérébraux peuvent prédire la nécessité de mettre en place un tube de gastrostomie par endoscopie percutanée chez les patients atteints d'un AVC.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 1 , January 2014 , pp. 24 - 28
Copyright
Copyright © The Canadian Journal of Neurological 2014

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