Abstract 62: Recovery-based Prediction of Who Is Using a G-tube at 6 Weeks Post-stroke

Abstract

Background: Decision-making regarding gastrostomy tube (G-tube) placement prolongs hospital stay in the inpatient stroke setting. Studies have predicted who receives G-tube placement at discharge, but have not assessed which factors predict who is actually using a G-tube long-term by assessing dysphagia recovery and G-tube needs in follow-up. Methods: Stroke patients from an inpatient stroke service were prospectively recruited if dysphagia was identified on the clinical speech therapy dysphagia test, defined as Mann Assessment of Swallowing Ability (MASA) score < 178. Variables associated with dysphagia were prospectively collected. G-tubes were placed in patients according to standard clinical practice based on speech therapy recommendations and family discussion. Follow-up included a 6 week swallowing quality of life survey (SWAL-QOL, 12 items including if a G-tube is currently being used). Univariate predictors of G-tube use at 6 weeks were assessed allowing calculation of a “G-tube Score” for prediction of who required a G-tube at 6 weeks. Score performance was measured by receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: Of 146 dysphagic patients (median NIHSS=15), 31% were discharged with a G-tube. Of those completing 6 week SWAL-QOL (N=61), 26% of patients who had received a G-tube, no longer needed a G-tube. Univariate predictors of needing a G-tube included: age ≥ 70 (p=0.017), NIHSS ≥ 18 (p=0.006), ICU admission (p=0.007), respiratory failure requiring intubation (p=0.001), and MASA score < 110 (p<0.0001). 4 and 5 point G-tube scores performed well in predicting 6 week G-tube needs (AUCs 0.88 and 0.92, respectively). The optimal cut-off for both scores, preserving sensitivity and maintaining specificity, was a score of 2 points (Fig). Conclusion: Carrying 2 of the following early factors: age ≥ 70, NIHSS ≥ 18, ICU admission, and intubation, yields a high likelihood of requiring a G-tube beyond 6 weeks post-stroke.