Abstract 91: An Objective Screening Tool Predicts Surgical Feeding Tube Placement in Acute Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kristin Brown ◽  
Andrew Barreto ◽  
Umair Saed ◽  
Chunyan Cai ◽  
Aurangzeb Memon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Subgroup Analysis ◽  
Prediction Models ◽  
Demographic Data ◽  
Feeding Tube ◽  
Tube Placement ◽  
Barium Swallow ◽  
Full Model ◽  
Endoscopic Gastrostomy

Introduction: Dysphagia is a common post-stroke complication, yet there are no standard tools to guide recommendations for placement of percutaneous endoscopic gastrostomy (PEG) tube. Prior prediction models in acute ischemic stroke (AIS) have had inconsistent findings and have not included objective swallowing assessments. We hypothesized that inclusion of an aspiration-based score would simplify the prediction model and be a strong independent predictor of PEG placement among patients referred for instrumental assessment of swallowing (IAS) after failed bedside swallow. Methods: Consecutive cases of AIS were identified from our inpatient registry (6/14- 4/15). Patients transferred to hospice or dying within 3 days of hospitalization were excluded. NIHSS and sub-items, medical history, and demographic data were included in the full model and subgroup analysis which included patients undergoing IAS. Univariate and multiple logistic regression were used to assess predictors of PEG placement. Penetration-Aspiration (PEN-ASP) scores (1-2 normal; 3-5, penetration, 6-8, aspiration) calculated using Fiberoptic Endoscopic Evaluation of Swallowing and Modified Barium Swallow Studies were included in the model for subgroup analysis. Results: Among 731 AIS patients, 17.9% (131) of patients received a PEG and 200 patients received IAS (39.5 % PEG). In the full model, arrival GCS and NIHSS, NIHSS level of consciousness score, and prior Diabetes Mellitus and ICH (p < 0.05). Among patients receiving IAS, arrival NIHSS, PEN-ASP score, and race (Hispanic v White) was associated with PEG placement. Conclusions: This study represents the largest cohort of AIS patients undergoing PEG placement and IAS. We demonstrated that the PEN-ASP score helps to predict PEG placement in AIS. Race also emerged as a predictor, and in future studies, we will examine patient and provider-level factors to explain this association.

Abstract TP327: Predictors of Surgical Feeding Tube Placement in Intracerebral Hemorrhage.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Umair Saeed ◽  
Kristin Brown ◽  
Anjail Sharrief ◽  
Hari Indupuru ◽  
Amber Jacobs ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Prediction Models ◽  
Feeding Tube ◽  
Tube Placement ◽  
Barium Swallow ◽  
Future Research ◽  
Speech Pathology ◽  
Stroke Severity ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Feeding Tube Placement

Introduction: Decisions to pursue enteral feeding with percutaneous endoscopic gastrostomy tube (PEG) may lead to prolong hospitalization in stroke patients. Prediction models in intracerebral hemorrhage (ICH) have shown conflicting data, lacked objective speech pathology findings, and have included race predictor without biological basis. We hypothesized that stroke severity and findings from instrumental swallowing assessments would predict PEG placement and race would not be a significant predictor after controlling for other variables. Methods: Using our prospectively obtained stroke registry, we analyzed consecutive ICH cases at our comprehensive stroke center. Patients transferred to hospice or died within 3 days were excluded. Backward stepwise elimination using logistic regression evaluated potential predictors of PEG placement. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Modified Barium Swallow (MBSS) studies utilized the validated Penetration-Aspiration (PEN-ASP) scale; an 8-item scale: 1-2, normal; 3-5, penetration; 6-8 aspiration. Results: Between June-14 and April-15, 290 ICH patients were treated by our stroke service (65.5% hospital transfers). Overall, 64 (21.4%) patients received PEG tubes with higher rates in non-whites (table). Ten variables with p<0.1 were identified (see table). In the final model, race was not significantly associated with PEG (p=0.092), but total NIHSS, sub-item 1a of the NIHSS, presentation to our ED and GCS remained independent predictors of PEG placement (p<.05). PEG patients had significantly worse PEN-ASP scores for both thin and nectar-thick liquids. Conclusions: Our work represents the largest cohort of ICH patients that underwent surgical feeding tube placement. We did not find an independent association with race as previously reported. Future research regarding dysphagia and stroke should include objective assessments of swallow function such as the PEN-ASP score.

scholarly journals Current practices in feeding tube placement for US acute ischemic stroke inpatients

Neurology ◽  
2014 ◽  
Vol 83 (10) ◽  
pp. 874-882 ◽  
Author(s):  
B. P. George ◽  
A. G. Kelly ◽  
E. B. Schneider ◽  
R. G. Holloway
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Feeding Tube ◽  
Tube Placement ◽  
Feeding Tube Placement ◽  
Current Practices

scholarly journals Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome

2021 ◽  
Vol 51 (1) ◽  
pp. E6
Author(s):  
Valerio Da Ros ◽  
Jacopo Scaggiante ◽  
Francesca Pitocchi ◽  
Fabrizio Sallustio ◽  
Simona Lattanzi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Demographic Data ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Endovascular Management ◽  
Retrograde Approach ◽  
Antegrade Approach ◽  
Tandem Occlusion

OBJECTIVE Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M1 middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. RESULTS In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4–0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. CONCLUSIONS ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CA-related TOs.

Abstract TP165: Mortality After Large Artery Occlusion Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rahul R Karamchandani ◽  
Jeremy Rhoten ◽  
Edwin Strong ◽  
Brenda Chang ◽  
Sam Singh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prediction Models ◽  
Univariate Analysis ◽  
Female Gender ◽  
Artery Occlusion ◽  
Large Artery ◽  
Multivariable Logistic Regression Model ◽  
Factors Associated ◽  
Social Security Death Index

Introduction: Despite randomized trials demonstrating the benefit of endovascular therapy (EVT), large artery occlusion (LAO) acute ischemic stroke (AIS) remains associated with high mortality. Identifying factors associated with mortality for patients presenting with LAO AIS can assist in therapeutic decision-making and prognostication. Hypothesis: Among patients with LAO AIS, factors associated with 90-day mortality include older age, higher presenting NIHSS score, and lower final Thrombolysis in Cerebral Infarction (TICI) score. Methods: From November 2016 to April 2019, we conducted a retrospective analysis from a large healthcare system’s stroke network registry of patients presenting with ICA and/or MCA occlusions. Ninety-day mortality status from registry follow-up was corroborated with the Social Security Death Index. A multivariable logistic regression model was fitted to determine demographic and clinical characteristics associated with 90-day mortality. Results: Among 796 patients with 800 encounters, mean age was 68 years, 52% were women, mean presenting NIHSS was 14, and 97% presented within 24 hours of last known well time. Fifty-one percent were treated with EVT. Mortality rate for the entire cohort was 25%. In a univariate analysis, there were significant differences in age, gender, race, blood glucose, presenting NIHSS, hypertension, atrial fibrillation, CTP core volume, CTP delayed perfusion volume, EVT treatment, number of passes for EVT, final TICI score, and discharge mRS, between patients with and without 90-day mortality. In the multivariable model, increasing age (per 10 years, OR 1.54, 95% CI 1.20, 1.97) and higher discharge mRS (per 1 point, OR 4.47, 95% CI 3.05, 6.55) were associated with 90-day mortality. Female gender (OR 0.57, 95% CI 0.27, 1.18) and final TICI score of 2B or better (OR 0.42, 95% CI 0.18, 1.01) were protective against 90-day mortality. Conclusions: Increasing age and worse discharge functional outcome are associated with 90-day mortality after LAO AIS. Female gender and better revascularization after EVT are associated with lower mortality. Additional studies are required to refine mortality outcome prediction models for patients presenting with LAO AIS.

scholarly journals Evaluating the Role of Oxidative Stress in Acute Ischemic Stroke

2020 ◽  
Vol 11 (01) ◽  
pp. 156-159
Author(s):  
Bindu Menon ◽  
Krishnan Ramalingam ◽  
Rajeev Kumar
Keyword(s):  
Oxidative Stress ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Lipid Membranes ◽  
Demographic Data ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Antioxidant Power

Abstract Background The role of oxidative stress in neuronal injury due to ischemic stroke has been an interesting topic in stroke research. Malondialdehyde (MDA) has emerged as a sensitive oxidative stress biomarker owing to its ability to react with the lipid membranes. Total antioxidant power (TAP) is another biomarker to estimate the total oxidative stress in stroke patients. We aimed to determine the oxidative stress in acute stroke patients by measuring MDA and TAP. Materials and Methods MDA and TAP were determined in 100 patients with ischemic stroke and compared with that in 100 age- and sex-matched healthy adults. Demographic data, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), and disability measured by the Barthel index (BI) were recorded. The association of MDA and TAP with other variables was analyzed by paired t-test. Results Of the whole sample, 74% represented males. The mean NIHSS score was 13.11 and BI was 38.87. MDA was significantly higher in stroke patients (7.11 ± 1.67) than in controls (1.64 ± 0.82; p = 0.00). TAP was significantly lower in stroke patients (5.72 ± 1.41) than in controls (8.53 ± 2.4; p = 0.00). The lipid profile and blood sugar levels were also significantly higher in stroke patients. There was no association of MDA and TAP with other variables. Conclusion We found that oxidative stress was associated with acute ischemic stroke. However, we could not establish an association between oxidative stress and the severity of acute stroke.

scholarly journals Gastrostomy Tube Placement by Radiological versus Endoscopic Methods in an Acute Care Setting: A Retrospective Review of Frequency, Indications, Complications and Outcomes

2009 ◽  
Vol 23 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Amy Galaski ◽  
Wei Wei Peng ◽  
Michelle Ellis ◽  
Pauline Darling ◽  
Andrew Common ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Feeding Tube ◽  
Tube Placement ◽  
Tube Insertion ◽  
Endoscopic Gastrostomy ◽  
Cost Differential ◽  
Gastrostomy Tube Placement ◽  
Group 3 ◽  
Percutaneous Radiological Gastrostomy ◽  
Endoscopic Methods

OBJECTIVES: To describe the current practice of placing gastrostomy tubes (endoscopic and radiological), patient characteristics, indications for enteral support, complications and outcomes over a 13-month period, and explore factors that influenced complications and outcomes. Second, to provide Canadian data regarding feeding tube placement because no current literature reflecting these practices for Canadian hospitals is available.METHODS: Retrospective chart reviews were conducted. Patients who had initial percutaneous endoscopic gastrostomy (PEG) or percutaneous radiological gastrostomy (PRG) tubes inserted for nutritional purposes were included in the study.RESULTS: A total of 136 charts which included 30 PEG and 44 PRG procedures were reviewed. The PRG group was older than the PEG group (mean [± SD] age 68±19 years versus 55±21 years, respectively; P=0.008). Patients in PEG group had longer lengths of hospital stay and more intensive care unit admissions than the PRG group (P=0.029). The main reason for tube insertion was dysphagia/aspiration (PEG [60%] and PRG [77%]). Minor complications were comparable between the two groups (P=0.678). There were three cases of major complications overall. More subjects in the PRG group died (18%) while in hospital than in the PEG group (3%) (P=0.055). No procedure-related deaths occured in either group.CONCLUSIONS: Both methods of tube insertion provided a safe route for nutrition delivery despite a significant cost differential with PEGs costing 44% more than PRGs. Characteristics such as age, presence of ascites and severity of disease influenced the method of insertion despite the lack of current guidelines. Overall, the present study provides new descriptive data in a Canadian context.

scholarly journals Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation

Stroke ◽  
2021 ◽  
Author(s):  
Femke Kremers ◽  
Esmee Venema ◽  
Martijne Duvekot ◽  
Lonneke Yo ◽  
Reinoud Bokkers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
The Netherlands ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Prediction Models ◽  
Predictive Performance ◽  
Data Availability ◽  
Vascular Events ◽  
Discriminative Performance

Background and Purpose: Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice. Methods: We systematically searched within Medline, Embase, Cochrane, Web of Science, to include prediction models. Models identified from the search were validated in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, which includes all patients treated with endovascular treatment within 6.5 hours after stroke onset in the Netherlands between March 2014 and November 2017. Predictive performance was evaluated according to discrimination (area under the curve) and calibration (slope and intercept of the calibration curve). Good functional outcome was defined as a score of 0–2 or 0–3 on the modified Rankin Scale depending on the model. Results: After screening 3468 publications, 19 models were included in this validation. Variables included in the models mainly addressed clinical and imaging characteristics at baseline. In the validation cohort of 3156 patients, discriminative performance ranged from 0.61 (SPAN-100 [Stroke Prognostication Using Age and NIH Stroke Scale]) to 0.80 (MR PREDICTS). Best-calibrated models were THRIVE (The Totaled Health Risks in Vascular Events; intercept −0.06 [95% CI, −0.14 to 0.02]; slope 0.84 [95% CI, 0.75–0.95]), THRIVE-c (intercept 0.08 [95% CI, −0.02 to 0.17]; slope 0.71 [95% CI, 0.65–0.77]), Stroke Checkerboard score (intercept −0.05 [95% CI, −0.13 to 0.03]; slope 0.97 [95% CI, 0.88–1.08]), and MR PREDICTS (intercept 0.43 [95% CI, 0.33–0.52]; slope 0.93 [95% CI, 0.85–1.01]). Conclusions: The THRIVE-c score and MR PREDICTS both showed a good combination of discrimination and calibration and were, therefore, superior in predicting functional outcome for patients with ischemic stroke after endovascular treatment within 6.5 hours. Since models used different predictors and several models had relatively good predictive performance, the decision on which model to use in practice may also depend on simplicity of the model, data availability, and the comparability of the population and setting.

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