New model for predicting surgical feeding tube placement in patients with an acute stroke event

Abstract

Background and purpose: The need for surgical feeding tube placement after acute stroke can be uncertain and associated with further morbidity.

Methods: Retrospective data were recorded and compared across patients with acute ischemic stroke and intracerebral hemorrhage. We identified all feeding tubes placed as percutaneous endoscopic gastrostomy (PEG) tubes. A prediction score for PEG tube placement was developed separately for patients with acute ischemic stroke and intracerebral hemorrhage using logistic regression models of variables known by 24 hours from admission.

Results: Of 407 patients included, 51 (12.5%) underwent PEG tube placement (25 acute ischemic stroke and 26 intracerebral hemorrhage). The odds of a patient with acute ischemic stroke with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (odds ratio, 15.68; 95% confidence interval, 4.55-54.01). The odds of a patient with intracerebral hemorrhage with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (odds ratio, 12.49; 95% confidence interval, 1.54-101.29).

Conclusions: The PEG score, comprised by variables known within the first day of admission, may be a powerful predictor of PEG placement in patients with acute stroke.

Keywords: acute ischemic stroke; enteral nutrition; gastric feeding tube; intracerebral hemorrhage.

Figure 1

A: Predicting PEG Placement in AIS Patients Figure 1B: Predicting PEG Placement in ICH Patients A) A maximum of 5 points can be achieved from the AIS-PEG model. An area under the curve of 0.8032 shows the model is very predictive of PEG tube placement. B) A maximum of 5 points can be achieved from the ICH-PEG model. An area under the curve of 0.7004 for the model shows a moderate predictive value of PEG tube placement. Abbreviations: Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), percutaneous endoscopic gastrostomy (PEG), receiver operator characteristic (ROC)

Figure 1

A: Predicting PEG Placement in AIS Patients Figure 1B: Predicting PEG Placement in ICH Patients A) A maximum of 5 points can be achieved from the AIS-PEG model. An area under the curve of 0.8032 shows the model is very predictive of PEG tube placement. B) A maximum of 5 points can be achieved from the ICH-PEG model. An area under the curve of 0.7004 for the model shows a moderate predictive value of PEG tube placement. Abbreviations: Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), percutaneous endoscopic gastrostomy (PEG), receiver operator characteristic (ROC)