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Crisan D, Shaban A, Boehme A, Dubin P, Juengling J, Schluter LA, Albright KC, Beasley TM, Martin-Schild S. Predictors of recovery of functional swallow after gastrostomy tube placement for Dysphagia in stroke patients after inpatient rehabilitation: a pilot study. Ann Rehabil Med 2014; 38:467-75. [PMID: 25229025 PMCID: PMC4163586 DOI: 10.5535/arm.2014.38.4.467] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/24/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine predictors of early recovery of functional swallow in patients who had gastrostomy (percutaneous endoscopic gastrostomy [PEG]) placement for dysphagia and were discharged to inpatient rehabilitation (IPR) after stroke. METHODS A retrospective study of prospectively identified patients with acute ischemic and hemorrhagic stroke from July 2008 to August 2012 was conducted. Patients who had PEG during stroke admission and were discharged to IPR, were studied. We compared demographics, stroke characteristics, severity of dysphagia, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow. RESULTS Patients who remained PEG dependent were significantly older (73 vs. 54 years, p=0.009). Recovery of swallow was more frequent for hemorrhagic stroke patients (80% vs. 47%, p=0.079). Age, adjusting for side of stroke (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.98; p=0.016) and left-sided strokes, adjusting for age (OR, 15.15; 95% CI, 1.32-173.34; p=0.028) were significant predictors of swallow recovery. Patients who recovered swallowing by discharge from IPR were more likely to be discharged home compared to those who remained PEG-dependent (90% vs. 42%, p=0.009). CONCLUSION Younger age and left-sided stroke may be predictive factors of early recovery of functional swallow in patients who received PEG. Prospective validation is important as avoidance of unnecessary procedures could reduce morbidity and healthcare costs.
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Affiliation(s)
- Diana Crisan
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Amir Shaban
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Amelia Boehme
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. ; Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Perry Dubin
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jenifer Juengling
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laurie A Schluter
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Karen C Albright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. ; Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. ; Health Services and Outcomes Research, Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, Birmingham, AL, USA. ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, Birmingham, AL, USA
| | - T Mark Beasley
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheryl Martin-Schild
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA. ; Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
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Dubin PH, Boehme AK, Siegler JE, Shaban A, Juengling J, Albright KC, Martin-Schild S. New model for predicting surgical feeding tube placement in patients with an acute stroke event. Stroke 2013; 44:3232-4. [PMID: 23963332 DOI: 10.1161/strokeaha.113.002402] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The need for surgical feeding tube placement after acute stroke can be uncertain and associated with further morbidity. METHODS Retrospective data were recorded and compared across patients with acute ischemic stroke and intracerebral hemorrhage. We identified all feeding tubes placed as percutaneous endoscopic gastrostomy (PEG) tubes. A prediction score for PEG tube placement was developed separately for patients with acute ischemic stroke and intracerebral hemorrhage using logistic regression models of variables known by 24 hours from admission. RESULTS Of 407 patients included, 51 (12.5%) underwent PEG tube placement (25 acute ischemic stroke and 26 intracerebral hemorrhage). The odds of a patient with acute ischemic stroke with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (odds ratio, 15.68; 95% confidence interval, 4.55-54.01). The odds of a patient with intracerebral hemorrhage with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (odds ratio, 12.49; 95% confidence interval, 1.54-101.29). CONCLUSIONS The PEG score, comprised by variables known within the first day of admission, may be a powerful predictor of PEG placement in patients with acute stroke.
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Affiliation(s)
- Perry H Dubin
- From the Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA (P.H.D., J.E.S., A.S., J.J., S.M.-S.); Doris Duke Charitable Foundation, Clinical Research Fellow, New York, NY (P.H.D.); Department of Epidemiology (A.K.B., K.C.A.), and Department of Neurology (A.K.B.), University of Alabama at Birmingham, AL; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, AL (K.C.A.); and Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, AL (K.C.A.)
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Stewart GW, McQueen-Borden E, Bell RA, Barr T, Juengling J. Comprehensive assessment and management of athletes with sport concussion. Int J Sports Phys Ther 2012; 7:433-447. [PMID: 22893863 PMCID: PMC3414075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
UNLABELLED Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary.The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals.Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | | | | | - Thomas Barr
- Tulane Institute of Sports Medicine, New Orleans, LA, USA
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