Percutaneous endoscopic gastrostomy tube placement in left versus right middle cerebral artery stroke: effects of laterality

• Published in: NeuroRehabilitation (Reading, Mass.) Vol. 33; no. 2; p. 201
• Main Authors: San Luis, Christa O'Hana V, Staff, Ilene, Ollenschleger, Martin D, Fortunato, Gilbert J, McCullough, Louise D
• Format: Journal Article
• Language: English
• Published: Netherlands 01-01-2013
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Deglutition Disorders - etiology; Deglutition Disorders - surgery; Enteral Nutrition - methods; Female; Gastroscopy; Gastrostomy; Humans; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - surgery; Male; Middle Aged; Retrospective Studies; Young Adult; Gastrostomy; dysphagia; functional laterality; endoscopy; middle cerebral artery infarction
• ISSN: 1878-6448
• DOI: 10.3233/NRE-130946

Prolonged dysphagia after middle cerebral artery (MCA) territory strokes may require percutaneous endoscopic gastrostomy (PEG) tube feeding.
We examined the predictors of PEG placement among patients with MCA stroke. It was hypothesized that stroke laterality was a predictor.
A retrospective cohort study of existing data from Hartford Hospital Stroke Database was done. A total of 157 patients with acute ischemic MCA stroke were included. Patients were divided into the "PEG" group (n = 24) and "no PEG" group (n = 133). Existing demographic, clinical and swallowing data were compared between the 2 groups.
Demographic data were similar between the groups. The "PEG" group had a higher admission National Institute of Health Stroke Scale (NIHSS) score, higher proportion of patients who had thrombolytic administration, in- hospital aspiration pneumonia and inability to be assessed on first swallow evaluation. Multivariate analysis revealed that all, except thrombolytic administration may predict PEG placement.
Admission NIHSS score, in-hospital aspiration pneumonia and inability to undergo first swallow evaluation may predict PEG placement in patients with acute MCA stroke. Stroke laterality was not associated. This knowledge facilitates early identification of patients that may require PEG tube placement for early nutrition provision and discharge to rehabilitation.