Abstract 149: Association of Ischemic Stroke Location and Demographic Variables with Percutaneous Endoscopic Gastrostomy Placement
Introduction: PEG is often necessary in patients with dysphagia after ischemic strokes (IS) to prevent aspiration. As cranial nerve nuclei responsible for swallowing are in the brainstem; it seems intuitive that IS in the posterior circulation (PC) would cause dysphagia requiring PEG. We describe current clinical practice patterns within a large, biracial population.
Methods: Within the Greater Cincinnati/Northern Kentucky region (population ∼1.3 million) we screened all 15 local hospitals’ admissions in 2010 using ICD-9 discharge codes 430-436. All cases were study physician confirmed. IS location was determined by brain imaging or study physician clinical impression. Demographic and clinical variables included age, race, sex, insurance status, baseline rNIHSS, atrial fibrillation (AF), dysphagia, thrombolysis, bi-hemispheric stroke, community or academic hospital, and volume of stroke admission. Logistic regression was used to evaluate associations between PEG and clinical/demographic characteristics.
Results: Our sample included 2168 patients with IS; 118 underwent PEG placement. The overall population was 55% women and 22% black. Of the PEG patients,62% were women and 32% were black. Median (range) age was 74 (66-83) yrs in PEG patients and 71 (58-82) in those without PEG. In patients with PC only stroke, 16/457 (3.5%) had a PEG, while 83/1365 (6.0%) of anterior circulation only stroke required PEG and 19/346 (5.5%) of patients with both anterior and PC stroke required PEG. Findings were not explained by differences in hospice/mortality rates. In multivariable analysis, black race, rNIHSS, AF, and dysphagia were strongly associated with PEG (table).
Conclusions: PC strokes were not more likely to undergo PEG placement compared to anterior circulation IS within our population. Further investigation is needed to understand the associations of PEG with black race and AF, including possible racial differences in approach to end-of-life care.
Author Disclosures: M. Star: None. H. Sucharew: Research Grant; Significant; R01NS30678. S. Ruland: None. C.J. Moomaw: Research Grant; Significant; R01NS30678. K. Alwell: Research Grant; Significant; R01NS30678. B.M. Kissela: Research Grant; Significant; R01NS30678. M. Flaherty: Research Grant; Modest; R01NS30678. D. Woo: Research Grant; Modest; R01NS30678. J. Mackey: Research Grant; Modest; R01NS30678. S. Martini: None. O. Adeoye: None. S. Ferioli: Research Grant; Modest; R01NS30678. F. De Los Rios La Rosa: None. D.O. Kleindorfer: Speakers' Bureau; Modest; Genentech. Research Grant; Significant; R01NS30678.
- © 2016 by American Heart Association, Inc.