B. K. Yorkgitis1, O. A. Olufajo2, L. Gurien1, E. Kelly2, A. Salim2, R. Askari2 1University Of Florida-Jacksonville,Acute Care Surgery,JAcksonville, FL, USA 2Brigham And Women’s Hospital,Trauma, Burns And Surgical Critical Care,Boston, MA, USA
Introduction: PEG tubes are a means of providing nutrition to patient that are unable to consume their caloric intake. PEG tubes placed in trauma patients after the acute trauma differ from commonly studies malignancy patients. Often, patients and/or care givers inquires about the length of time alternative means of nutrition will be required. Our aim was to identify risk factors for prolong need for PEG tube (>90 days).
Methods: The trauma database of a Level I, urban trauma center was used to identify all trauma patients who had PEG tubes placed between January 1, 2009 to December 31, 2014. Exclusions included age <18 years, pregnancy, patients without follow-up evaluations, and those with pre-existing PEG tubes. Variables examined included: age, sex, injury severity score (ISS), initial GCS, admission albumin, ventilator days, ICU days, hospital LOS, and Charlson Comorbidity Index (CCI). Multivariable logistic regression models were used to identify risk factors for having PEG tubes >90 days.
Results:
During the study period 9772 charts were reviewed for PEG tube placement. Of these patients, 285 (2.9%) underwent attempted PEG tube, of which 281 (98.9%) were successful. Five attempts were aborted due inadequate visualization; one was able to be subsequently placed with an additional attempt. There were 9 (3.2%) in-hospital deaths in patients successfully receiving PEG tube placement during their index trauma admission; none were related to the procedure. There were 18 (6.2%) PEG tube related complications. Upon review of the living patients at discharge, 195 had adequate clinical documentation of PEG tube presence or decannulation status to allow for analysis.
Of these patients, 149 (76.4%) were male, the average age was 57.5 years with 80 (41.0%) being over 65 years. The average admitting albumin was 3.7 g/dL and CCI was 1.1. First recorded mean GCS was 10.7 and ISS 23.2. The mean hospital LOS was 23.8 days, ICU LOS 16.5 days and ventilator days while in the hospital was 11.5 days. The mean CCI was 1.1.
The findings are summarized in Table 1. Of those requiring a PEG tube during their index admission, 77 (41.4%) required their PEG tube >90 days. Statistically significant characteristics identified upon univariate analysis include increasing age, age>65 years, higher CCI and longer in-hospital ventilator days. Upon logistic regression, CCI>1 (OR1.27, CI 95% 1.03-1.56, p=0.02) and longer in-hospital ventilator days (OR 1.05 CI 95% 1.02-1.09, p<0.01) were predictive of need for prolonged PEG tube.
Conclusion:
Patients and their surrogates often inquire about the length of time a PEG tube may be needed after trauma. This retrospective chart review identified CCI>1 and prolonged in-hospital ventilator days as risk factors for necessity of PEG tube >90 days. This may assist clinicians and patients or their surrogates in decision making when faced for the need for alternative routes for nutrition.