Gastrostomy in Hospitalized Patients with Acute Stroke: ``NoroTek'' Turkey Point Prevalence Study Subgroup Analysis

Abstract

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NoroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients {[}female: 53\%, age: 69 +/- 14

acute ischemic stroke in 845

intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7\% of the patients with ischemic stroke, 10.1\% of the patients with ICH and in 50\% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission {[}exp (ss): 1.09 95\% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke

and mechanical ventilation in ischemic {[}exp (ss): 6.18 (95\% CI: 3.16-12.09)] and hemorrhagic strokes {[}exp (ss): 26.48 (95\% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome {[}exp (ss): 0.032 (95\% CI: 0.004-0.251)] but not of in-hospital mortality {[}exp (ss): 1.731 (95\% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69\% and 76\% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39\% of the patients. In 83.5\% of them, tube was inserted in the first 2 days

28\% of the patients with feeding tube had PEG later. Conclusion: The NoroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.