Chung-Han Ho1, Wen-Chih Lin2, Ya-Fang Hsu3, I-Hui Lee4, Yi-Chieh Hung5. 1. Department of Medical Research, Chi-Mei Medical Center, Tainan City, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. 2. Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Chiali, Tainan, Taiwan. 3. Department of Physical Medicine and Rehabilitation, Hung Surgery Hospital, Tainan, Taiwan. 4. Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan. 5. Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Electronic address: ygmilloy@gmail.com.
Abstract
BACKGROUND: In the early stages of stroke, the use of a nasogastric tube can reduce complications such as malnutrition, dehydration, and pneumonia. However, its long-term efficacy is controversial. METHODS: This retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate associations among dysphagia, rate of readmission due to pneumonia, and mortality 1 year after stroke. Patients who had received their first stroke diagnosis and inpatient rehabilitation from January 1, 2006, to December 31, 2010, were enrolled. The presence of dysphagia was determined by the number of nasogastric tubes received (≥2 was classified as dysphagia, <2 as control). Kaplan-Meier plots with log-rank tests revealed differences between the 2 groups, and a Cox regression model was used to estimate the hazard ratio. RESULTS: There were 5032 patients in the dysphagia group and 52,323 patients in the control group. The dysphagia group had a higher probability and incidence of pneumonia (18.78% versus 6.52%, P < .001 and adjusted hazard ratio [AHR] = 2.00, 95% confidence interval [CI] = 1.84-2.16) and a higher mortality rate (10.45% versus 4.77%, P < .001; AHR = 1.61, 95% CI = 1.46-1.79) 1 year after stroke. CONCLUSIONS: The association persisted until the 5-year poststroke time point. Our results suggest that prolonged nasogastric tube use has negative effects. Intensive evaluation of dysphagia and removal of the nasogastric tube in the early stages of stroke might reduce pneumonia incidence and mortality.
BACKGROUND: In the early stages of stroke, the use of a nasogastric tube can reduce complications such as malnutrition, dehydration, and pneumonia. However, its long-term efficacy is controversial. METHODS: This retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate associations among dysphagia, rate of readmission due to pneumonia, and mortality 1 year after stroke. Patients who had received their first stroke diagnosis and inpatient rehabilitation from January 1, 2006, to December 31, 2010, were enrolled. The presence of dysphagia was determined by the number of nasogastric tubes received (≥2 was classified as dysphagia, <2 as control). Kaplan-Meier plots with log-rank tests revealed differences between the 2 groups, and a Cox regression model was used to estimate the hazard ratio. RESULTS: There were 5032 patients in the dysphagia group and 52,323 patients in the control group. The dysphagia group had a higher probability and incidence of pneumonia (18.78% versus 6.52%, P < .001 and adjusted hazard ratio [AHR] = 2.00, 95% confidence interval [CI] = 1.84-2.16) and a higher mortality rate (10.45% versus 4.77%, P < .001; AHR = 1.61, 95% CI = 1.46-1.79) 1 year after stroke. CONCLUSIONS: The association persisted until the 5-year poststroke time point. Our results suggest that prolonged nasogastric tube use has negative effects. Intensive evaluation of dysphagia and removal of the nasogastric tube in the early stages of stroke might reduce pneumonia incidence and mortality.
Authors: Yeongjun James Park; Chia-Hung Yo; Wan-Ting Hsu; Eric Po-Yang Tsou; Yu-Chiang Wang; Dean-An Ling; An-Fu Lee; Michael A Liu; Chien-Chang Lee Journal: J Acute Med Date: 2021-12-01
Authors: Timo Siepmann; Annahita Sedghi; Jessica Barlinn; Katja de With; Lutz Mirow; Martin Wolz; Thomas Gruenewald; Sina Helbig; Percy Schroettner; Simon Winzer; Simone von Bonin; Haidar Moustafa; Lars-Peder Pallesen; Bernhard Rosengarten; Joerg Schubert; Andreas Gueldner; Peter Spieth; Thea Koch; Stefan Bornstein; Heinz Reichmann; Volker Puetz; Kristian Barlinn Journal: J Neurol Date: 2020-08-06 Impact factor: 4.849