Abstract Details

Title Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement in Middle Cerebral Artery Acute Ischemic Stroke and Stroke Laterality

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 018

Objective

Background BACKGROUND: Dysphagia is a common complication after strokes involving the cerebral hemispheres. If persistent, alternative means of nutrition including percutaneous endoscopic gastrostomy (PEG) tube feeding are necessary. Predictors of PEG tube placement in patients with middle cerebral artery (MCA) territory strokes have not been examined. We also determined if laterality (right vs. left) of stroke predicted PEG tube placement in this subset of patients.

Design/Methods DESIGN/METHODS: We retrospectively reviewed existing data in our institution's stroke database of patients presenting to Hartford Hospital with an acute ischemic MCA stroke between January 2005 and December 2010. Demographic, clinical (e.g. NIHSS on admission, intervention done) and swallowing data (e.g. timing of swallowing, number of swallow evaluations before PEG placement, dysphagia severity) were gathered. Volume of infarction of patients who underwent PEG was calculated. All variables that showed statistical difference (p<.05) between patients who did and did not undergo PEG placement in univariate analysis were entered into a multivariate logistic regression analysis to identify independent predictors of PEG placement.

Results RESULTS: 157 patients were included. The variables NIHSS on admission, administration of IA or IV tPA, aspiration pneumonia and ability to be assessed on first swallow evaluations were entered into the multivariate logistic regression analysis after determining that these variables with the exception of arterial and venous thrombolytic administration were independent predictors of PEG placement. Stroke laterality was not an independent predictor of PEG placement.

Conclusions CONCLUSIONS: Our study indicates that high NIHSS on admission, aspiration pneumonia and inability to undergo first swallow evaluation are independent predictors of PEG placement in patients with acute MCA strokes. This knowledge can be used for early identification of patients that require PEG tube placement to provide prompt nutritional support.

Authors/Disclosures
Christa O'hana S. Nobleza, MD PRESENTER	Dr. Nobleza has nothing to disclose.
Louise D. McCullough, MD, PhD (McGovern Medical School, UTHealth)	The institution of Dr. McCullough has received research support from NIH. The institution of Dr. McCullough has received research support from American Heart Association.
Martin D. Ollenschleger, MD (Jefferson Radiology)	No disclosure on file
	No disclosure on file
Antonios Bayas	No disclosure on file
	No disclosure on file

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