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Abstract Details

Development and validation of a risk score to estimate outcomes after feeding tube placement in acute stroke
Cerebrovascular Disease and Interventional Neurology
S52 - Acute Non-Interventional Stroke Care (3:30 PM-3:41 PM)
001
Dysphagia is a common complication of acute stroke, and severe cases can lead to DET placement for long-term feeding.  Patients with DET have high mortality and severe disability, however no tool exists to predict outcomes prior to DET placement.
To create a bedside risk assessment tool to predict outcomes in patients with severe dysphagia who require direct enteral tube (DET; gastrostomy/jejunostomy) placement.

We used the Ontario Stroke Registry and linked databases between 2003-2013 to identify patients who received DET after admission for acute stroke.  We defined ‘poor outcome’ as modified Rankin Scale (mRS) score 5 at discharge or death at 90 days, and ‘good outcome’ as mRS 0-3 at discharge and alive at 90 days.   We used multiple logistic regression to identify variables significantly associated with the outcomes and adjusted for age, sex, pre-admission independence, prior stroke, dementia, atrial fibrillation, vascular co-morbidities, stroke type, face/arm/leg weakness and severity, admission location, endotracheal intubation, tracheostomy, and timing of DET.  We derived a point score from the model beta coefficients, and measured model discrimination and calibration using c-statistic and Hosmer-Lemeshow test, respectively.  We used data from 2003-2008 for derivation and 2009-2013 for validation of the score.

There were 912 patients in the derivation and 450 patients in the validation cohorts.  The odds of poor outcome increased with older age, severe leg weakness, atrial fibrillation, and tracheostomy, and decreased with prior independence and stroke unit admission.  The odds of good outcome increased with prior independence, and decreased with older age, hemorrhagic stroke, and severe leg weakness.  The c-statistics in the validation cohort were 0.64 and 0.82 for poor and good outcome, respectively, and calibration was good.
We found multiple predictors associated with outcomes after DET placement for acute stroke.  Our novel score could facilitate decision-making for patients with severe dysphagia being considered for DET.
Authors/Disclosures
Raed Joundi, MD, PhD
PRESENTER
Dr. Joundi has nothing to disclose.
Gustavo Saposnik, MD (Director, Clinical Outcomes & Decision Neuroscience Research Centre) Dr. Saposnik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Saposnik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIHSS. The institution of Dr. Saposnik has received research support from Roche. The institution of Dr. Saposnik has received research support from Heart and Stroke Foundation of Canada.
No disclosure on file
No disclosure on file
Moira Kapral, MD (Toronto General Hospital) The institution of Moira Kapral, MD has received research support from Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research.