Post-stroke dysphagia is common and ranges in severity. Identifying severe dysphagia is critical to avoid prolonged hospital length of stay and malnutrition. The purpose of this study was to describe characteristics and predictors of acute stroke patients with severe dysphagia requiring gastrostomy tube (G-tube). We retrospectively reviewed data from an IRB-approved stroke registry at two Comprehensive Stroke Centers (CSC) from 10/24/2022 and 8/30/2024. We included hospitalized patients with acute ischemic (AIS) or intracerebral hemorrhage (ICH) who failed initial dysphagia screening. Pre-stroke modified Rankin Scale (mRS) of ≥3 was excluded to account for poor baseline function. To assess predictors of G-tube placement, this sample was compared with a cohort from the same stroke registry who failed dysphagia screening but improved to oral diet by discharge. Demographic and clinical characteristics were examined. Descriptive and frequency statistics were used to characterize the cohort. Chi-squared and correlations were used to compare groups. G-tube placement occurred in 28 patients (5.2%) with median NIHSS 17 (range 0-30). There were more males (n=18; 64.3%) than females (n=10; 35.7%). Median time to G-tube was 11.5 days and Palliative Care consults were obtained in 10.7% (n=3). Thrombolysis was administered in 17.9% of patients and 35.7% underwent embolectomy (EVT). Large vessel occlusion (LVO) was seen in 75% of patients, left proximal MCA was the most common LVO site (28.6%, n=8). Cardioembolic strokes were the most frequent stroke etiology (53.6%). Pneumonia was diagnosed in 64.3%, aphasia was present in 60.7%, and video swallow screening occurred in 71.4%. At discharge, 60.7% of the G-tube patients had mRS 5 and 82.1% were discharged to a skilled nursing facility. When compared to acute stroke patients who failed initial dysphagia screening but improved to discharge on oral diet, G tube placement was significantly correlated with NIHSS (p=<0.001); altered LOC (p=0.013); and EVT (p=0.004). Dysphagia requiring G-tubes occurred in a small but clinically significant subset of acute stroke patients, most of whom presented with high NIHSS and LVOs. Pneumonia and poor functional outcomes were common. Compared with patients who recovered to oral intake, G-tube placement was associated with stroke severity, altered LOC, and EVT. Early recognition of high-risk features can guide dysphagia management and G-tube decision-making.
Hu et al. (Thu,) studied this question.