Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement in Patients With Severe Dysphagia From an Acute-Subacute Hemispheric Infarction
Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement in Patients With Severe Dysphagia From an Acute-Subacute Hemispheric Infarction
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DOI：
10.1016/j.jstrokecerebrovasdis.2010.05.010
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发表时间：
2012-02-01
影响因子：
2.5
通讯作者：
Schlaug, Gottfried
中科院分区：
文献类型：
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作者：
Kumar, Sandeep;Langmore, Susan;Schlaug, Gottfried
本研究调查了年龄、美国国立卫生研究院卒中量表（NIHSS）评分、卒中发生时间、梗死部位和体积对急性-亚急性半球梗死后严重吞咽困难患者经皮内镜胃造口术（PEG）插管的影响。我们对一个以医院为基础的患者队列进行了回顾性分析，以分析上述变量对是否放置PEG管的决定的影响。使用国际疾病分类第九版（ICD-9）急性缺血性卒中代码，语言病理学家进行正式吞咽评估的现行程序术语(CPT)-4代码，以及我们机构现有医疗记录中5年期间PEG放置的程序代码，对连续患者进行识别。仅纳入了严重吞咽困难的患者。共有77例患者符合纳入标准；其中20例行PEG置入术。采用logistic回归分析年龄（二分法；<和>= 75岁）、卒中发生时间（天）、NIHSS评分、急性梗死灶体积（二分法；<和>= 100 cc）、梗死部位（即脑岛、脑岛前部、脑室周围白质、额下回、运动皮层或双侧半球）与PEG管置入的关系。在单因素分析中，NIHSS评分（P = 0.005）、病变体积（P = 0.022）和双脑梗死的存在（P = 0.005）被发现是主要的预测因素。多因素调整后，只有NIHSS评分（优势比[OR]， 1.15； 90%置信区间[CI]， 1.02-1.29; P = 0.04）和双脑梗死的存在（优势比[OR]， 4.67； 90%置信区间[CI]， 1.58-13.75; P = 0.018）仍然显著。我们的数据表明，基线NIHSS评分和双半球梗死的存在可以预测严重吞咽困难患者急性-亚急性半球梗死住院期间PEG的放置。这些结果需要在未来的研究中进一步验证。
This study investigated the influence of age, National Institutes of Health Stroke Scale (NIHSS) score, time from stroke onset, infarct location and volume in predicting placement of a percutaneous endoscopic gastrostomy (PEG) tube in patients with severe dysphagia from an acute-subacute hemispheric infarction. We performed a retrospective analysis of a hospital-based patient cohort to analyze the effect of the aforementioned variables on the decision of whether or not to place a PEG tube. Consecutive patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for acute ischemic stroke, Current Procedural Terminology (CPT)-4 codes for a formal swallowing evaluation by a speech pathologist, and procedure codes for PEG placement over a 5-year period from existing medical records at our institution. Only patients with severe dysphagia were enrolled. A total of 77 patients met inclusion criteria; 20 of them underwent PEG placement. The relationship between age (dichotomized; < and >= 75 years), time from stroke onset (days), NIHSS score, acute infarct lesion volume (dichotomized; < and >= 100 cc), and infarct location (ie, insula, anterior insula, periventricular white matter, inferior frontal gyrus, motor cortex, or bilateral hemispheres) with PEG tube placement were analyzed using logistic regression analysis. In univariate analysis, NIHSS score (P = .005), lesion volume (P = .022), and presence of bihemispheric infarction (P = .005) were found to be the main predictors of interest. After multivariate adjustment, only NIHSS score (odds ratio [OR], 1.15; 90% confidence interval [CI], 1.02-1.29; P = .04) and presence of bihemispheric infarcts (OR, 4.67; 90% CI, 1.58-13.75; P = .018) remained significant. Our data indicates that baseline NIHSS score and the presence of bihemispheric infarcts predict PEG placement during hospitalization from an acute-subacute hemispheric infarction in patients with severe dysphagia. These results require further validation in future studies.