S.A. Cleverdon2, T.W. Costantini1,2, T.M. McGrew3, J.E. Santorelli1,2, A.E. Berndtson1,2, L.N. Haines1,2 1University Of California – San Diego, Trauma, Surgical Critical Care And Burns, San Diego, CA, USA 2University Of California – San Diego, School Of Medicine, San Diego, CA, USA 3University Of Texas Southwestern – Austin, Dell Medical School, Austin, TX, USA
Introduction: For patients with moderate to severe TBI, percutaneous gastrostomy (PEG) placement may be needed to ensure enteral feeding access for patients expected to have prolonged dysphagia. Predicting the duration of dysphagia for patients recovering from TBI is difficult making identification of the appropriate patients from PEG tube placement a challenge. The aim of this study was to characterize predictors of needing PEG tube placement after moderate to severe TBI.
Methods: This was a retrospective review of a Level I trauma center’s registry between 1/1/2019 and 6/30/2024. Inclusions criteria were patients ≥15 years with a moderate (GCS 9-13) to severe (GCS 3-8) TBI and documentation of swallowing function. Variables included age, sex, race, polytrauma (any non-head AIS>2), ISS, and mortality. Primary outcome was PEG tube placement indicating prolonged dysphagia. Multivariate logistic regression was performed to assess for predictors of PEG adjusting for variables significant on univariate analyses.
Results: There were 314 patients who met study criteria, the mean age was 52.5±1.3 years and 72.9% male. Overall, 45.2% had a moderate TBI and 54.8% with severe TBI, and 68.2% of patients had isolated head injuries. Overall, dysphagia was diagnosed in 63.1% of patients and PEG tubes were placed in 10.5% of patients. Tracheostomy was performed in 69 patients, of those 28 (40.6%) underwent PEG placement. Overall mortality was 12.7%.
On univariate analysis patients with PEG tubes were significantly younger at 41.5±3.2 vs 53.8±22.5 years (p=0.003), however there was no difference in sex, race, or ethnicity. Of severe TBI patients 14.5% had a PEG placed vs 5.6% with a moderate TBI (p=0.010). See Table for additional univariate analyses. On multivariate logistic regression, predictors of PEG tubes were tracheostomy (OR 19.4 CI 4.9-76.4, p<0.001) and insurance type (Medicaid OR 10.375 CI 2.4-45.4, p=0.002 & Self-Pay OR 39.9 CI 2.0-782.5, p=0.015). Dysphagia and TBI severity were not predictors.
Conclusions: The majority of patients with moderate to severe TBI had dysphagia; however, most of these patients did not require PEG placement prior to discharge from the hospital. It is concerning that insurance status was a predictor of PEG placement, additional research is needed to assess for causes of this disparity. These data suggest that careful consideration of need for PEG tube placement in patients with dysphagia especially those without a tracheostomy.