Abstract Details

Title Patients with Stroke and Dysphagia: Demographics and Trends in Percutaneous Endoscopic Gastrotomy Tube Use in Stroke Patients in the United States from 1988-2010

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 219

Objective

Background BACKGROUND: Dysphagia is present in 25-50% of stroke patients and increases risk of aspiration pneumonia and malnutrition. Early use of supplemental feedings improves functional, but not cognitive outcome in stroke survivors. There is little data on the utilization of PEG for acute stroke patients in the US.

Design/Methods DESIGN/METHODS: Using the Nationwide Inpatient Sample, a 20% stratified sample of all US hospitalizations, from 1988 - 2010 we identified all admissions for stroke and analyzed the utilization of PEG. The Charlson-Deyo index was used to control for co-morbidities, age was dichotomized at median age, and trend in utilization was examined by dividing the admissions in five epochs. Logistic regression was used to control for confounders. With the large number of records anticipated, p was set a priori at < .0001.

Results RESULTS: Of 2.7 million stroke admissions identified, PEG was used in 3.68%. Over time the rate of PEG placement significantly increased from 2.64% to 4.05%. Discharge to LTCF was twice as common with PEG (75 vs 32%). The difference in mortality was not significant 8.48% (PEG) vs 8.78%. In final regression model aspiration pneumonia was strongly associated with PEG placement (OR 4.655; 95% CI: 4.560-4.752), followed by epoch 2006-2010 vs 1988-1990 (2.372; 2.317-2.429); Charlson index > 4 compared to 0 (1.862; 1.817-1.909), UTI (1.733; 1.703-1.763), age > median (74) (1.656; 1.631-1.681), urban-teaching hospital vs rural (1.250; 1.219-1.282), urban non-teaching vs rural (1.281; 1.250-1.312), and for length of stay (1.159; 1.158-1.160 for each day).

Conclusions CONCLUSIONS: The use of PEG tubes has increased over time in US hospital admissions for acute stroke, and was associated with multiple comorbidities, greater length of stay and age > 74. This shows the increasing awareness of post-stroke dysphagia.

Authors/Disclosures
Kimberly D. Johnson, MD (Kansas City VA Hospital) PRESENTER	No disclosure on file
Richard M. Dubinsky, MD, MPH, FAAN (University of Kansas Medical Center)	Dr. Dubinsky has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie Pharmaceuticals. An immediate family member of Dr. Dubinsky has stock in Abbvie and Abbott Labs. The institution of Dr. Dubinsky has received research support from CHDI. The institution of Dr. Dubinsky has received research support from Prilenia. The institution of Dr. Dubinsky has received research support from Sage Pharmaceuticals. The institution of Dr. Dubinsky has received research support from NIH/NINDS. Dr. Dubinsky has a non-compensated relationship as a Member, independent data safety monitoring board with Roche that is relevant to AAN interests or activities.
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital)	Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.

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