Predictors of Recovery of Functional Swallow After Gastrostomy Tube Placement for Dysphagia in Stroke Patients After Inpatient Rehabilitation: A Pilot Study.
10.5535/arm.2014.38.4.467
- Author:
Diana CRISAN
1
;
Amir SHABAN
;
Amelia BOEHME
;
Perry DUBIN
;
Jenifer JUENGLING
;
Laurie A SCHLUTER
;
Karen C ALBRIGHT
;
T Mark BEASLEY
;
Sheryl MARTIN-SCHILD
Author Information
1. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA. awshaban@gmail.com
- Publication Type:Original Article
- Keywords:
Gastrostomy;
Acute ischemic stroke;
Rehabilitation;
Dysphagia
- MeSH:
Deglutition;
Deglutition Disorders*;
Demography;
Gastrostomy*;
Health Care Costs;
Humans;
Inpatients*;
Pilot Projects*;
Prospective Studies;
Rehabilitation*;
Retrospective Studies;
Stroke*;
Unnecessary Procedures
- From:Annals of Rehabilitation Medicine
2014;38(4):467-475
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To determine predictors of early recovery of functional swallow in patients who had gastrostomy (percutaneous endoscopic gastrostomy [PEG]) placement for dysphagia and were discharged to inpatient rehabilitation (IPR) after stroke. METHODS: A retrospective study of prospectively identified patients with acute ischemic and hemorrhagic stroke from July 2008 to August 2012 was conducted. Patients who had PEG during stroke admission and were discharged to IPR, were studied. We compared demographics, stroke characteristics, severity of dysphagia, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow. RESULTS: Patients who remained PEG dependent were significantly older (73 vs. 54 years, p=0.009). Recovery of swallow was more frequent for hemorrhagic stroke patients (80% vs. 47%, p=0.079). Age, adjusting for side of stroke (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.98; p=0.016) and left-sided strokes, adjusting for age (OR, 15.15; 95% CI, 1.32-173.34; p=0.028) 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). CONCLUSION: 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.
