Gastrostomy in Hospitalized Patients with Acute Stroke: “NöroTek” Turkey Point Prevalence Study Subgroup Analysis

Mehmet Akif Topçuoğlu1, Atilla Özcan Özdemir2, Özlem Aykaç2, Aysel Milanoğlu3, Mustafa Gökçe4, Songül Bavli4, Murat Çabalar5, Vildan Yayla5, Hacı Ali Erdoğan5, Ayça Özkul6, Aygül Güneş7, Bahar Değirmenci8, Ufuk Aluçlu8, Hasan Hüseyin Kozak9, Levent Güngör10, Mücahid Erdoğan11, Zeynep Özdemir Acar11, Utku Cenikli12, Yüksel Kablan13, Arda Yılmaz14, Hamit Genç14, Bijen Nazliel15, Hale Batur Çağlayan15, Elif Sarıönder Gencer16, Halil Ay17, Hayri Demirbaş18, Özlem Akdoğan19(0000000286564581), Ufuk Emre19, Özlem Kayım Yıldız20, Aslı Bolayır20, Turgay Demir21, Zeynep Tanrıverdi22, Ülgen Yalaz Tekan22, Çetin Kürşad Akpınar23, Esra Özkan24, Faik İlik25, Hadiye Şirin26, Ayşe Güler26, Halil Önder27, Hesna Bektaş28, Levent Öcek29, Mustafa Bakar30, Nedim Ongun31, Yakup Krespi32, Canan Togay Işıkay33, Eda Aslanbaba33, Mine Sorgun33, Erdem Gürkaş34, Hasan Hüseyin Karadereli35, İpek Midi36, İrem İlgezdi37, Adnan Burak Bilgiç37, Şener Akyol37, M. Tuncay Epçeliden38, Murat Mert Atmaca39, Oğuzhan Kurşun40, Onur Keskin41, Pınar Bekdik Şirinocak42, Recep Baydemir43, Merve Akçakoyunlu43, Şerefnur Öztürk44, Tuğba Özel45, Ali Ünal45, Babür Dora45, Vedat Ali Yürekli46, Zülfikar Arlıer47, Alper Eren48, Ayşe Yılmaz49(0000000263543550), Ayşin Kısabay50, Bilgehan Acar51, Birgül Baştan52, Zeynep Acar52, Buket Niflioğlu53, Bülent Güven54, Dilaver Kaya55, Nazire Afşar55, Duran Yazıcı56, Emrah Aytaç57, Erdem Yaka58, Eren Toplutaş59, Eylem Değirmenci60, Fatma Birsen İnce61, Gülseren Büyükşerbetçi62, İsa Aydın63, Mustafa Çetiner64, Mustafa Şen65, Nilda Turgut66, Nilüfer Kale67, Eda Çoban67, Nilüfer Yeşilot68, Esme Ekizoğlu68, Özgü Kizek68, Özlem Birgili69, Recep Yevgi70, Refik Kunt71, Semih Giray72, Sinem Yazıcı Akkaş73, Songül Şenadım74, Tahir Yoldaş75, Talip Asil76, Taşkın Duman77, Tuğrul Atasoy78, Bilge Piri Çınar78, Tülin Demir79, Ufuk Can80, Yaprak Özüm Ünsal81, Neslihan Eşkut81, Yıldız Aslan82, Demet Funda Baş82, Ufuk Şener82, Zahide Yılmaz83, Zehra Bozdoğan84, Zekeriya Alioğlu85, Ethem Murat Arsava1

1Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
2Osmangazi University Faculty of Medicine, Department of Neurology, Eskisehir, Turkey
3Van Yuzuncu Yil University Faculty of Medicine, Department of Neurology, Van, Turkey
4Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Neurology, Kahramanmaras, Turkey
5University of Health Sciences Turkey, Istanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
6Aydin Adnan Menderes University Faculty of Medicine, Department of Neurology, Aydin, Turkey
7University of Health Sciences Turkey, Bursa High Specialisation Training and Research Hospital, Stroke Unit, Bursa, Turkey
8Dicle University Faculty of Medicine, Department of Neurology, Diyarbakir, Turkey
9Necmettin Erbakan University Faculty of Medicine, Department of Neurology, Konya, Turkey
10Ondokuz Mayis University Faculty of Medicine, Department of Neurology, Samsun, Turkey
11Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Nervous Diseases Training and Research Hospital Neurology, Intensive Care Unit, Istanbul, Turkey
12Sitki Kocman University Faculty of Medicine, Department of Neurology, Mugla, Turkey
13Inonu University Faculty of Medicine, Department of Neurology, Malatya, Turkey
14Mersin University Faculty of Medicine, Department of Neurology, Mersin, Turkey
15Gazi University Faculty of Medicine, Department of Neurology, Ankara, Turkey
16University of Health Sciences Turkey, Antalya Training and Research Hospital, Clinic of Neurology, Antalya, Turkey
17Harran University Faculty of Medicine, Department of Neurology, Sanliurfa, Turkey
18Afyon Kocatepe University Faculty of Medicine, Department of Neurology, Afyon, Turkey
19University of Health Sciences Turkey, Istanbul Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
20Sivas Cumhuriyet University Faculty of Medicine, Department of Neurology, Sivas, Turkey
21Cukurova University Faculty of Medicine, Department of Neurology, Adana, Turkey
22University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
23Samsun Training and Research Hospital, Clinic of Neurology, Samsun, Turkey
24Tokat State Hospital, Clinic of Neurology, Tokat, Turkey
25Konya Medicana Hospital, Department of Neurology, Konya, Turkey
26Ege University Faculty of Medicine, Department of Neurology, Izmir,, Turkey
27Yozgat City Hospital, Clinic of Neurology, Yozgat, Turkey
28Ankara City Hospital, Clinic of Neurology, Ankara, Turkey
29Usak State Hospital, Clinic of Neurology, Usak, Turkey
30Bursa Uludağ University Faculty of Medicine, Department of Neurology, Bursa, Turkey
31Burdur State Hospital, Clinic of Neurology, Burdur, Turkey
32Istanbul Aydın University Faculty of Medicine; VM Florya Medikal Park Hospital; Comprehensive Stroke Center; Istanbul and Pendik Medikal Park Hospital; Istanbul and Istinye University; Bahcesehir Liv Hospital, Istanbul, Turkey
33Ankara University Faculty of Medicine, Department of Neurology, Ankara, Turkey
34University of Health Sciences Turkey, Gulhane Training and Research Hospital, Clinic of Neurology, Ankara, Turkey
35Medeniyet University Faculty of Medicine, Department of Neurology, Istanbul, Turkey
36Marmara University Faculty of Medicine, Department of Neurology, Istanbul, Turkey
37Giresun University Faculty of Medicine, Department of Neurology, Giresun, Turkey
38Kemer State Hospital, Clinic of Neurology, Antalya, Turkey
39University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
40Ankara City Hospital, Clinic of Neurology, Ankara, Turkey
41Eskisehir Yunus Emre State Hospital, Clinic of Neurology, Eskisehir, Turkey
42University of Health Sciences Turkey, Derince Training and Research Hospital, Clinic of Neurology, Kocaeli, Turkey
43Erciyes University Faculty of Medicine, Department of Neurology, Kayseri, Turkey
44Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey
45Akdeniz University Faculty of Medicine, Department of Neurology, Antalya, Turkey
46Suleyman Demirel University Faculty of Medicine, Department of Neurology, Afyon, Turkey
47Baskent University, Adana Application and Research Center, Department of Neurology, Adana, Turkey
48Ataturk Training and Research Hospital, Clinic of Neurology, Erzurum, Turkey
49Bakırkoy Mental and Nervous Diseases Hospital, Clinic of Neurology, Istanbul, Turkey
50Manisa Celal Bayar University Faculty of Medicine, Department of Neurology, Manisa, Turkey
51Sakarya University Faculty of Medicine, Department of Neurology, Sakarya, Turkey
52University of Health Sciences Turkey, Istanbul Haseki Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
53Mus State Hospital, Clinic of Neurology, Mus, Turkey
54University of Health Sciences Turkey, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Neurology, Ankara, Turkey
55Acibadem University Faculty of Medicine; Altunizade Hospital, Department of Neurology, Istanbul, Turkey
56Ordu State Hospital, Clinic of Neurology, Ordu, Turkey
57Firat University Faculty of Medicine, Department of Neurology, Elazıg, Turkey
58Dokuz Eylul University Faculty of Medicine, Department of Neurology, Izmir, Turkey
59Istanbul Medipol University Faculty of Medicine, Department of Neurology, Istanbul, Turkey
60Pamukkale University Faculty of Medicine, Department of Neurology, Denizli, Turkey
61Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul, Turkey
62Balikesir University Faculty of Medicine, Department of Neurology, Balikesir, Turkey
63Balikligol State Hospital, Clinic of Neurology, Sanliurfa, Turkey
64Dumlupinar University Faculty of Medicine, Department of Neurology, Kutahya, Turkey
65Yalova State Hospital, Clinic of Neurology, Yalova, Turkey
66Tekirdag Namik Kemal University Faculty of Medicine, Department of Neurology, Tekirdag, Turkey
67Istanbul Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Nervous Diseases Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
68Istanbul University Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
69Edirne State Hospital, Clinic of Neurology, Edirne, Turkey
70Erzurum Regional Training and Research Hospital, Clinic of Neurology, Erzurum, Turkey
71Aydin State Hospital, Neurology Service, Aydin, Turkey
72Gaziantep University Faculty of Medicine, Department of Neurology, Gaziantep, Turkey
73University of Health Sciences Turkey, Istanbul Bagcilar Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
74Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
75Ankara Training and Research Hospital, Clinic of Neurology, Ankara, Turkey
76Memorial Hizmet Hospital, Department of Neurology, Istanbul, Turkey
77Mustafa Kemal University Faculty of Medicine, Department of Neurology, Hatay, Turkey
78Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Neurology, Zonguldak, Turkey
79Sanliurfa Training and Research Hospital, Clinic of Neurology, Sanliurfa, Turkey
80Baskent University Faculty of Medicine, Department of Neurology, Ankara, Turkey
81University of Health Sciences Turkey, Izmir Bozyaka Training and Research Hospital, Neurology Service, Izmir, Turkey
82University of Health Sciences Turkey, Izmir Tepecik Training and Research Hospital, Clinic of Neurology, Izmir, Turkey
83University of Health Sciences Turkey, Derince Training and Research Hospital, Clinic of Neurology, Kocaeli, Turkey
84Kars Harakani State Hospital, Neurology Service, Kars, Turkey
85Karadeniz Technical University Faculty of Medicine, Department of Neurology, Trabzon, Turkey

Keywords: Stroke, intracerebral hemorrhage, malnutrition, dysphagia, flash mob

Abstract

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases.

Materials and Methods: NöroTek 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 (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 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 (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 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 NöroTek 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.

Ethics Committee Approval

The NöroTek study was initiated with the approval of Hacettepe University NonInterventional Ethics Committee for clinical studies consortia (decision no: GO 18/331-16).

Peer Review

Externally and internally peer-reviewed.

Author Contributions

Surgical and Medical Practices: All authors, Concept: M.A.T., A.O.Ö., E.M.A., Design: M.A.T., A.O.Ö., E.M.A., Data Collection or Processing: All authors, Analysis and Interpretation: M.A.T., Literature Search: M.A.T., Writing (first draft): M.A.T., Writing (review & editing): All authors.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study received no financial support.