Abstract TP374: Risk Assessment Scale for the Consideration of Long-Term Alternate Means of Nutrition

Abstract

Objectives: The decision to utilize percutaneous enteral feeding for hospital patients after stroke or as a result neurological disease is based on qualitative measures. There is no defined protocol for the evaluation of patients who may require alternative means of feeding such as a PEG tube. We developed a quantitative scale HOGLIO scale.We developed a quantitative scale to determine which patients with neurologic disease/deficits will require Percutaneous Enteral Gastrostomy. The scale identifies patients at risk for aspiration by applying a score based on patient’s (a) level of arousal as measure by the Observational Scale Level of Arousal (OSLA),(b)respiratory status as measured by peripheral capillary oxygen saturation (c)aspiration risk as measured by formal bedside swallow evaluation/instrumental assessment (d)Long term nutritional needs as measured by patient’s ability to meet nutritional needs orally. Methods: We conducted a prospective registry review of patients with consultation for speech and swallow on the stroke ward at our comprehensive stroke Center, between June-July 2019. The following variables were collected for each patients; Age ,NIH score, OSLA score, HOGLIO score, vital signs ,medication list and per oral diet status. Result: The patients ranged in age from 21-85 years with mean age of 63.6 years. Patients with H score > 10 need PEG. We found that the strongest correlation between the need for PEG and H score was in the level of consciousness .Our preliminary data indicate that score greater than 10 is a good indicator for PEG.A high score on the Level of Arousal testing appears to be indicative of a need for PEG, as is a failed barium swallow, and a failed bedside swallowing test. Conclusion: Historically patients with neurological disease are at risk of aspiration. The PEG tube can be used to improve nutrition and meet metabolic needs of patients at higher risk of aspiration. It is cost effective and associated with lower complications compared to parenteral nutrition. The pilot study may suggest a relationship between HOGLIO score, risk of aspiration and need for an alternative route of nutrition such as PEG. We propose to carry out our study on a larger number of patients to further understand the relationships.