Ann Rehabil Med.  2021 Feb;45(1):33-41. 10.5535/arm.20149.

Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke

• Jang BS
• Park JY
• Lee JH
• Sim YJ
• Jeong HJ
• Kim GC

• KMID: 2513228
• DOI: http://doi.org/10.5535/arm.20149

Abstract

Objective
To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.
Methods
This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.
Results
There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.
Conclusion
In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.

Keyword

Dysphagia, Stroke, Gastrostomy

Figure

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  Fig. 1. Receiver operating characteristic (ROC) curve of the Functional Dysphagia Scale (FDS) and Penetration-Aspiration Scale (PAS) for successful gastrostomy tube weaning.

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  Fig. 2. Causes of tube reinsertion (n=9) in the weaning group.

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