Abstract WP291: Outcomes and Predictors of Percutaneous Endoscopic Gastrostomy tube placement in Acute Ischemic Stroke versus Intracerebral Hemorrhage

Abstract

Background: The circumstances for morbidity differ between acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). The need for Percutaneous Endoscopic Gastrostomy (PEG) tube placement may be associated with further morbidity. This study aims to identify differences in outcomes between AIS and ICH patients who undergo PEG placement. Methods: We conducted a retrospective analysis of patients admitted consecutively within 24 hours of acute stroke to Tulane University Hospital from 07/2008-12/2010. Demographic and clinical data were recorded throughout admission and compared across patients with AIS and ICH using Chi square and t-test with nonparametric tests when appropriate. A prediction score was developed separately for AIS and ICH patients by using 55% of the dataset and tested on the remaining 45%. Associations were further evaluated as potential score variables using logistic regression. ROC curves were used to evaluate the final score. Results: Seventy-six patients who had a PEG placed were identified and included in the analyses (42 AIS and 34 ICH). Of patients with PEG, a greater proportion of ICH patients had dysarthria (p=0.0137) or impaired consciousness (p=0.0018) on admission than AIS patients. Patients with ICH and PEG had more tracheostomy placement (p=0.0216), increased length of stay (8 vs. 6 days; p=0.0005), increased discharge NIHSS Score (21 vs. 3; p<0.0001), and increased discharge modified Rankin Scale (4 vs 3; p<0.0001) compared to patients with AIS and PEG. The odds of an AIS patient with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (OR 25.806, 95% CI 11.370-58.572). The odds of an ICH patient with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (OR 4.627, 95% CI 1.839-11.642). Conclusions: The PEG score may be a powerful predictor of PEG placement in patients with acute stroke. Impaired consciousness and dysarthria are significant driving forces in PEG placement in ICH vs. AIS patients.