Predictors Of Need For Peg Placements In Patients Following Acute Stroke

Nutrition Research Newsletter, March, 2000

Approximately 45% of patients admitted to the hospital following an acute hemispheric stroke experience dysphagia. However, one study reports that only 16% of dysphagia persists at one week post-stroke. The duration and frequency of dysphagia depend upon the site of the stroke. In individuals with dysphagia following a stroke, nasogastric tubes can be a reliable means of providing fluid and nutrition in the short-term. Percutaneous endoscopic gastrostomy (PEG) feeding tubes have benefits in individuals needing long-term (greater than four weeks) means of nutrition support. At present, there are no guidelines to aid in determining which stroke patients will need long-term support. The aim of a recent study was to determine the clinical predictors of long-term enteral feeding following a stroke.

Researchers reviewed medical records of acute stroke victims receiving PEG placement from 1995 to 1998. Comorbid illnesses, stroke subtypes, Glasgow scores, swallow evaluations, and time of PEG placement were evaluated in 32 patients. Mean follow-up was four months. PEG tubes were placed a mean of 8.4 days following the stroke. Swallow evaluation was abnormal in 21 of the 23 patients tested. At the time of final follow-up, only five of the patients receiving a PEG regained swallowing function in less than four weeks and no longer needed the PEG. The patients that regained swallowing ability were younger than the mean, had a mild dysphagia and had fewer numbers of comorbid illnesses when compared to the individuals that did not regain swallow function.

It can be concluded that a mild dysphagia, younger age, and fewer comorbid illnesses may be predictors that indicate short-term (less than four weeks) need for nutrition support. These patients may best be nourished via a nasogastric feeding tube.

J. Scolapio, M. Romano, J. Meschia, et al., PEG Feeding Tube Placement Following a Stroke: When to Place, When to Wait, Nutrition in Clinical Practice 15: 36-39 (February 2000) ]Correspondence: James S. Scolapio, MD, Division of Gastroenterology and Hepatology, 4500 San Pablo Rd., Jacksonville, FL 32224.]