Timing of Direct Enteral Tube Placement and Outcomes after Acute Stroke.
BACKGROUND
Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after stroke.


METHODS
We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute ischemic stroke or intracerebral hemorrhage between 2003 and 2013 who received DET (gastrostomy or jejunostomy) during their hospital admission. We grouped patients by week of DET placement and evaluated mortality at 30 days and 6 months after DET insertion, and disability at discharge. We used Cox proportional hazard models and multiple logistic regression to determine the association between time from admission to DET placement and outcomes, adjusting for patient and hospital factors.


RESULTS
In the study sample of 1367 patients, the median time from admission to DET placement was 17 days. After adjustment, each week of delay to DET placement was associated with lower mortality at 30 days (adjusted hazard ratio [aHR] .88, 95% confidence interval [CI] .79-.98), but not at 6 months (aHR .98, 95% CI .91- 1.05), and a higher likelihood of severe disability at discharge (adjusted odds ratio 1.35, 95% CI 1.13- 1.60).


CONCLUSIONS
Later DET placement after stroke was associated with lower 30-day mortality but higher severe disability at discharge. Further research is needed to understand the reasons for these observations and to optimize patient selection and timing of DET.
['Joundi|Raed A|RA|', 'Saposnik|Gustavo|G|', 'Martino|Rosemary|R|', 'Fang|Jiming|J|', 'Kapral|Moira K|MK|']
D000368:Aged D000369:Aged, 80 and over D016208:Databases, Factual D003679:Deglutition D003680:Deglutition Disorders D004185:Disability Evaluation D004750:Enteral Nutrition D005260:Female D005774:Gastrostomy D006801:Humans D007582:Jejunostomy D008297:Male D009864:Ontario D020127:Recovery of Function D012042:Registries D018570:Risk Assessment D012307:Risk Factors D020521:Stroke D000071939:Stroke Rehabilitation D013997:Time Factors D061665:Time-to-Treatment D016896:Treatment Outcome
timing feeding tubes DET Dysphagia PEG stroke outcomes