Predictors of Direct Enteral Tube Placement After Acute Stroke

Objective: To determine predictors of direct enteral tube (DET) placement after acute stroke. Methods: We used the Ontario Stroke Registry to identify patients who received direct enteral tubes (gastrostomy or jejunostomy) during hospital stay after acute ischemic stroke or intracerebral hemorrhage from July 1, 2003 to March 31, 2013. We used multivariable logistic regression to identify predictors of receiving DET after stroke. Results: Among 38,192 patients with acute stroke who met inclusion criteria, 1851 (4.9%) had DET placement during admission. We identified multiple variables significantly associated with DET placement, spanning patient demographics, comorbid illnesses, clinical, and hospital factors. The strongest predictors of receiving DET were stroke severity (adjusted odds ratio [aOR] 4.77 for severe versus mild stroke, 95% confidence interval [CI] 4.20-5.41), receiving a swallowing test within 72 hours (aOR 3.46, 95% CI 3.0-3.99), and in-hospital stroke (aOR 2.07, 95% CI 1.57-2.72). Conclusions: There are a number of predictors of DET placement within multiple domains. These findings may facilitate discussions around the possibility of requiring DET during admission. Further work is required to improve patient selection and timing of DET placement after acute stroke.