Novel Score Predicting Gastrostomy Tube Placement in Intracerebral Hemorrhage

Abstract

Background and Purpose— Dysphagia after intracerebral hemorrhage (ICH) contributes significantly to morbidity, often necessitating placement of a percutaneous endoscopic gastrostomy (PEG) tube. This study describes a novel risk prediction score for PEG placement after ICH. Methods— We retrospectively analyzed data from 234 patients with ICH presenting during a 4-year period. One hundred eighty-nine patients met inclusion criteria. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting predictors of PEG placement based on strength of association. Results— Age (odds ratio [OR], 1.64 per 10-year increase in age; 95% confidence interval [CI], 1.02–2.65), black race (OR, 3.26; 95% CI, 0.96–11.05), Glasgow Coma Scale (OR, 0.80; 95% CI, 0.62–1.03), and ICH volume (OR, 1.38 per 10-mL increase in ICH volume) were independent predictors of PEG placement. The final model for score development achieved an area under the curve of 0.7911 (95% CI, 0.6931–0.8892) in the validation group. The score was named the GRAVo score: Glasgow Coma Scale ≤12 (2 points), Race (1 point for black), Age >50 years (2 points), and ICH Volume >30 mL (1 point). A score >4 was associated with ≈12× higher odds of PEG placement when compared with a score ≤4 (OR, 11.81; 95% CI, 5.04–27.66), predicting PEG placement with 46.55% sensitivity and 93.13% specificity. Conclusions— The GRAVo score, combining information about Glasgow Coma Scale, race, age, and ICH volume, may be a useful predictor of PEG placement in ICH patients.