Abstract
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.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
