Structured Nutritional Support Pathway Using PRESS Increases Efficiency in GT Placement, Discharge


Researchers used predictive swallowing score to help guide decision making in gastric tube placement.

Amr Jijakli, MD, MPH, research collaborator, Research Collaborator, Beth Israel Deaconess Medical Center

Amr Jijakli, MD, MPH

Data from a recent study suggest that a structured nutritional support pathway using predictive swallowing score (PRESS) can increase efficiency of gastric tube (GT) placement and increase discharges with nasogastric tube (NGT) placement in poststroke patients with dysphagia.

These findings were presented at the American Stroke Association’s International Stroke Conference (ISC) 2021, March 17-19, by Amr Jijakli, MD, MPH, research collaborator, Research Collaborator, Beth Israel Deaconess Medical Center.

“Post-stroke dysphagia is common and can lead to aspiration pneumonia and death. Prediction tools and structured pathways for establishing nutritional support after stroke have been lacking until the development,” Jijakli and colleagues wrote.

“At our center, we decided to implement the use of PRESS to guide GT versus NGT placement for early discharge to acute rehabilitation facilities, create a rapid pathway for replacement of NGTs in the ED for discharged patients, and an outpatient day surgery GT placement pathway for patients who do not progress to safe swallowing during acute rehabilitation,” they continued.

The researchers hypothesized that a structured pathway leveraging PRESS to guide clinical decision-making could reduce decision-making time regarding GT placement, increase discharges with NGTs, and reduce hospitalization length of stay (LOS). 

READ MORE: Mobile Stroke Units Superior to Standard Management in 90-Day Stroke Outcomes

Jijakli and colleagues conducted a retrospective cohort study at the comprehensive stroke center at Tufts Medical Center. The study included patients admitted with acute ischemic stroke (IS) that failed a dysphagia screen. Patients were stratified in 2 groups: the preintervention group A admitted between July and December 2019, and the post-intervention group B (utilizing the structured nutritional support pathway including calculation of PRESS) admitted between January and June 2020. 

The researchers analyzed outcomes including number of days from arrival to GT insertion decision (ATG), discharge with NGT, and LOS. They used the Wilcoxin rank test to compare ATG and LOS between groups and Fisher’s exact test to compare discharge with NGT rates. 

Jijakli and colleagues analyzed data from a total of 121 patients, 58 (48%) in group A and 63 (52%) in group B. GT was recommended in 20 (17% total); 8 (14%) in group A and 12 (19%) in group B. The researchers found that the median ATG was longer in group A (4.5 days) than group B (1.5 days; P = .004). One patient (2%) in group A and 4 patients (8%) in group B were discharged with NGT (P = .36). Median LOS was the same in both groups (5 days; P = .81).

“A structured nutritional support pathway can guide clinical decision making, resulting in reduced time needed to decide on GT placement and increasing discharges with NGT,” Jijakli and colleagues concluded.

For more coverage of ISC 2021, click here.

Jijakli A, Skeels K, Leung L. Structured nutritional support pathway using predictive swallowing score to guide decision-making with post-stroke dysphagia. Presented at International Stroke Conference 2021; March 17–19. Abstract LB P29
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