Abstract Details

Title Predictors of Recovery of Functional Swallow after Gastrostomy Tube Placement for Dysphagia in Stroke Patients after Inpatient Rehabilitation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 066

Objective

Background BACKGROUND: Patients with persistent dysphagia require enteral feeding in order to be discharged to IPR. Unfortunately, PEG tube placement contributes to morbidity and adverse psychological effects.

Design/Methods DESIGN/METHODS: A retrospective review of prospectively identified patients with acute ischemic and hemorrhagic stroke from 7/2008-8/2012 was performed. Patients who had PEG during stroke admission and were discharged to IPR were included in the analysis. We compared demographics, stroke characteristics, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow.

Results RESULTS: Of the 1364 patients presented to our center, 8% (n=104) received PEG. Hemorrhagic stroke was associated with significantly higher odds of having PEG placed (18% vs 5%, OR 3.995, 95%CI 2.581-6.180, p<0.001). Patients who remained PEG dependent were significantly older (73 vs 54; p=0.009) but had similar baseline and discharge NIHSS. Recovery of swallow was more frequent for hemorrhagic compared to ischemic stroke (80% vs 47%, p=0.079) and left-sided strokes compared to right-sided and bilateral strokes (80% vs 44%, p=0.143). Patients prescribed antidepressants at stroke discharge had a significantly higher swallow recovery percentage (75% vs 33%, p=0.030) than those not treated. Age, adjusting for side of stroke, (OR 0.89, 95% CI 0.82-0.98, p=0.0164) and left-sided strokes, adjusting for age, (OR 15.15, 95%CI 1.32-173.34, p=0.0289) 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).

Conclusions CONCLUSIONS: Younger 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.

Authors/Disclosures
Diana Crisan, MD (Southampton Hospital Stony Brook) PRESENTER	No disclosure on file
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
Michael P. Collins, MD (Medical College of WI-Dept. of Neurology)	Dr. Collins has nothing to disclose.
Amir Shaban, MD (University of Iowa)	Dr. Shaban has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
	No disclosure on file
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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