Predictors of Percutaneous Endoscopic Gastrostomy Placement in Acute Ischemic Stroke

Brown, Kristin; Cai, Chunyan; Barreto, Andrew D; Shoemaker, Paige; Woellner, Jade; Vu, Kim; Xavier, Andreaa; Saeed, Umair; Watkins, Jeffrey N.; Savitz, Sean I; Sharrief, Anjail

doi:10.1016/j.jstrokecerebrovasdis.2018.07.022

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…This implies that the male gender is more likely to receive recommendations for tube feeding. This is similar to previous studies that reported that the male gender was associated with post-stroke dysphagia, pneumonia, and feeding tube placement [27][28][29]. Our patients with bilateral hemisphere involvement were more likely to be in the not improved group (3 of 7) and none of them were in the well-maintained group.…”

Section: Discussionsupporting

confidence: 91%

Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

et al. 2020

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Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

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Section: Discussionsupporting

confidence: 91%

Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

et al. 2020

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“…In contrast, in a retrospective analysis of patients with neurological dysphagia, a statistically significant decrease in the number of pneumonia episodes among patients receiving PEG feeds was observed when compared to NG feeds. 18 Brown et al (2018) evaluated the utility of the penetration-aspiration scale in predicting PEG tube placement among a sub-group of patients with ischemic stroke who had failed an initial bedside evaluation by a speech-language pathologist. They found high penetration-aspiration scale scores of 6-8 and moderate penetration-aspiration scale scores of 3-5 were associated with increased odds of PEG tube placement, but their study was not able to evaluate long-term clinical outcomes or swallow function.…”

Section: Discussionmentioning

confidence: 99%

“…They found high penetration-aspiration scale scores of 6-8 and moderate penetration-aspiration scale scores of 3-5 were associated with increased odds of PEG tube placement, but their study was not able to evaluate long-term clinical outcomes or swallow function. 19 Limited data are available regarding the efficacy of intervention in the prevention of pulmonary events, changes in patient's perception of swallowing severity over time and longterm outcomes following treatments. 20,21 The use of modified diet textures and thickened liquids has become a cornerstone of clinical practice to address swallowing dysfunction, yet the efficacy of this has been brought into question in the literature.…”

Section: Discussionmentioning

confidence: 99%

Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

Hanna

Randall

2021

J. Laryngol. Otol.

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Objective Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time. Method This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities. Results This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88). Conclusion Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

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“…Findings included increased likelihood of developing dysphagia or PEG placement for racial minorities, [65][66][67][69][70][71] individuals with low income, 65,66 and those with public insurance. 65,67,68 Of note, five of the seven studies found that Asian background was associated with either higher risk of dysphagia or PEG placement. 65,67,[69][70][71] In a retrospective review of nearly 50,000 intracerebral hemorrhage admissions, Faigle et al found that the odds of PEG placement were highest among Asians/Pacific Islanders (odds ratio 1.62, 95% CI 1.32-1.99, P < .001) and blacks (odds ratio 1.42, 95% CI 1.28-1.59, P < .001).…”

Section: Deglutitive Disordersmentioning

confidence: 99%

Healthcare Disparities in Laryngology: A Scoping Review

et al. 2020

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Objectives/Hypothesis: This scoping review aims to map out existing disparities research within the subspecialty of laryngology in order to highlight gaps in knowledge and guide future research.Study Design: Scoping Review.Methods: We completed a scoping review of PubMed, Ovid Embase, and the Cochrane Library for primary research focused on evaluating the existence and impact of disparities in race/ethnicity, sex/gender, insurance status, education level, income, geography, and LGBTQ identity in the context of various laryngological conditions. Publications of any design and date, performed in the United States, and focusing on the adult population exclusively were included.Results: Of the 4,999 unique abstracts identified, 51 articles were ultimately included. The most frequently examined condition in relation to disparities was laryngeal cancer (27 of 51), followed by voice disorders (15 of 51), deglutitive disorders (eight of 51), and airway disorders (one of 51). Sources of inequity evaluated from most common to least common were race/ethnicity (43 of 51), sex/gender (39 of 51), insurance status (23 of 51), geography (23 of 51), income (21 of 51), and education level (16 of 51). No study examined the association of LGBTQ identity with inequity.Conclusions: This scoping review highlights the limited extent of disparities research in laryngology and establishes the need for further scholarship on the impact of disparities in laryngology care. The pathologies studied were, in decreasing order of frequency: laryngeal cancer, voice disorders, deglutitive disorders, and airway disorders. Race/ethnicity and sex/gender were the most common disparities examined, with no evaluation of LGBTQ-related care inequity.

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Predictors of Percutaneous Endoscopic Gastrostomy Placement in Acute Ischemic Stroke

Cited by 16 publications

References 17 publications

Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

Healthcare Disparities in Laryngology: A Scoping Review

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