Gastrostomy in Hospitalized Patients with Acute Stroke: NoroTek Turkey Point Prevalence Study Subgroup Analysis
Date
SEP2022
Author
Topcuoglu, MA; Ozdemir, AO; Aykac, O; Milanoglu, A; Gokce, M; Bavli, S; Cabalar, M; Yayla, V; Erdogan, HA; Ozkul, A; Gunes, A; Degirmenci, B; Aluclu, U; Kozak, HH; Gungor, L; Erdogan, M; Acar, ZO; Cenikli, U; Kablan, Y; Yilmaz, A; Genc, H; Nazliel, B; Caglayan, HB; Gencer, ES; Ay, H; Demirbas, H; Akdogan, O; Emre, U; Yildiz, OK; Bolayir, A; Demir, T; Tanriverdi, Z; Tekan, UY; Akpinar, CK; Ozkan, E; Ilik, F; Sirin, H; Guler, A; Onder, H; Bektas, H; Ocek, L; Bakar, M; Ongun, N; Krespi, Y; Isikay, CT; Aslanbaba, E; Sorgun, M; Gurkas, E; Karadeli, HH; Midi, I; Ilgezdi, I; Bilgic, AB; Akyol, S; Epceliden, MT; Atmaca, MM; Kursun, O; Keskin, O; Sirinocak, PB; Baydemir, R; Akcakoyunlu, M; Ozturk, S; Ozel, T; Unal, A; Dora, B; Yurekli, VA; Arlier, Z; Eren, A; Yilmaz, A; Kisabay, A; Acar, B; Bastan, B; Acar, Z; Niflioglu, B; Guven, B; Kaya, D; Afsar, N; Yazici, D; Aytac, E; Yaka, E; Toplutas, E; Degirmenci, E; Ince, FB; Buyukserbetci, G; Aydin, I; Cetiner, M; Sen, M; Turgut, N; Kale, N; Coban, E; Yesilot, N; Ekizoglu, E; Kizek, O; Birgili, O; Yevgi, R; Kunt, R; Giray, S; Akkas, SY; Senadim, S; Yoldas, T; Asil, T; Duman, T; Atasoy, T; Cinar, BP; Demir, T; Can, U; Unsal, YO; Eskut, N; Aslan, Y; Bas, DF; Sener, U; Yilmaz, Z; Bozdogan, Z; Alioglu, Z; Arsava, EM
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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.
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