Abstract T P245: Time to Percutaneous Endoscopic Gastrostomy (PEG) Placement and National Institutes of Health Stroke Scale (NIHSS) Correlations in Acute Ischemic Stroke (AIS)

Abstract

Purpose: American Heart Association 2013 guidelines for AIS management emphasize the use of PEG feeding for patients who cannot take solids/liquids orally and a 2-3 week preference for NG after stroke onset. Recent studies suggest 14-28 days before a PEG is placed. Concerns about shortened time-intervals between AIS and PEG placement have arisen, possibly averting rehabilitation of a patient capacity to swallow. High NIHSS scores may be predictive of a patient need for PEG placement. The pilot study was to investigate PEG placement timing and correlation of the NIHSS in patients admitted with AIS in a 5-campus hospital system. Methods: Adult patients (18-99yrs) with AIS ICD-9 primary discharge codes, correlated with PEG placement procedural codes, and NIHSS scores Sept 2012 to Jun 2013. All patients were determined unable to safely swallow, requiring enteral feeding prior to discharge. Patients with chronic dysphagia, previous PEG, traumatic brain injury, intracranial/subarachnoid hemorrhage were excluded. Retrospective chart audit of 56 cases initially identified, 22 final AIS patients had PEG placement for dysphagia prior to hospital discharge with NIHSS documentation. Results: Final cohort statistics: 7 females (32%) and 15 males (68%); mean patient age 78.9 years, median of 78.5 years. Mean number of days between acute onset/admission and PEG placement 12.1 days, median of 7.0 days. Mean admission NIHSS scale was 16.6 points, median 17.5 points. Mean NIHSS score at PEG placement was 19.5 points, median 21 points. 16 patients (72.7%) with NIHSS of 14 points or greater, a score previously correlated with poor long-term rehabilitation outcomes. Comparison of admission NIHSS to NIHSS at the time of PEG placement, 13 patients (59%) had an equal or increased score. Conclusions: Significantly shorter PEG interval times than currently recommended were noted, with high NIHSS. Current rationales are not well understood. Further research is needed to insure ‘allow for swallow’ recovery in the dysphagic AIS patient while mitigating risk of malnutrition and aspiration.