Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion

Darcy Holt, Janice F McDonald, M L Murray, Christopher S Hair, David A Devonshire, Boyd Josef Gimnicher Strauss, Gregory Thomas Charles Moore

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4 Citations (Scopus)

Abstract

Percutaneous endoscopic gastrostomy (PEG) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of PEG placement, nor any to predict clinical outcome. AIM: The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of PEG placement is predictive of mortality in the short and medium terms. METHODS: A prospective audit was undertaken of all requests for PEG placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a PEG was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral. RESULTS: During the period 2005-2008, 198 patients were referred for PEG; 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty-four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4 vs 74.6 , P <0.0001) and 150 days (82.1 vs 57.9 , P = 0.0001) compared with all other patients. Patients who received PEG despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive PEG. CONCLUSION: The application of selection criteria by trained assessors improves patient selection for PEG insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from PEG. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit - in these patients, the procedure may have been fu
Original languageEnglish
Pages (from-to)648 - 652
Number of pages5
JournalInternal Medicine Journal
Volume45
Issue number6
DOIs
Publication statusPublished - 2015

Cite this

@article{b5366cbb28914a05a48d95ec21c06257,
title = "Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion",
abstract = "Percutaneous endoscopic gastrostomy (PEG) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of PEG placement, nor any to predict clinical outcome. AIM: The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of PEG placement is predictive of mortality in the short and medium terms. METHODS: A prospective audit was undertaken of all requests for PEG placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a PEG was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral. RESULTS: During the period 2005-2008, 198 patients were referred for PEG; 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty-four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4 vs 74.6 , P <0.0001) and 150 days (82.1 vs 57.9 , P = 0.0001) compared with all other patients. Patients who received PEG despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive PEG. CONCLUSION: The application of selection criteria by trained assessors improves patient selection for PEG insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from PEG. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit - in these patients, the procedure may have been fu",
author = "Darcy Holt and McDonald, {Janice F} and Murray, {M L} and Hair, {Christopher S} and Devonshire, {David A} and Strauss, {Boyd Josef Gimnicher} and Moore, {Gregory Thomas Charles}",
year = "2015",
doi = "10.1111/imj.12705",
language = "English",
volume = "45",
pages = "648 -- 652",
journal = "Internal Medicine Journal",
issn = "1444-0903",
publisher = "Wiley-Blackwell",
number = "6",

}

Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion. / Holt, Darcy; McDonald, Janice F; Murray, M L; Hair, Christopher S; Devonshire, David A; Strauss, Boyd Josef Gimnicher; Moore, Gregory Thomas Charles.

In: Internal Medicine Journal, Vol. 45, No. 6, 2015, p. 648 - 652.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion

AU - Holt, Darcy

AU - McDonald, Janice F

AU - Murray, M L

AU - Hair, Christopher S

AU - Devonshire, David A

AU - Strauss, Boyd Josef Gimnicher

AU - Moore, Gregory Thomas Charles

PY - 2015

Y1 - 2015

N2 - Percutaneous endoscopic gastrostomy (PEG) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of PEG placement, nor any to predict clinical outcome. AIM: The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of PEG placement is predictive of mortality in the short and medium terms. METHODS: A prospective audit was undertaken of all requests for PEG placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a PEG was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral. RESULTS: During the period 2005-2008, 198 patients were referred for PEG; 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty-four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4 vs 74.6 , P <0.0001) and 150 days (82.1 vs 57.9 , P = 0.0001) compared with all other patients. Patients who received PEG despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive PEG. CONCLUSION: The application of selection criteria by trained assessors improves patient selection for PEG insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from PEG. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit - in these patients, the procedure may have been fu

AB - Percutaneous endoscopic gastrostomy (PEG) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of PEG placement, nor any to predict clinical outcome. AIM: The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of PEG placement is predictive of mortality in the short and medium terms. METHODS: A prospective audit was undertaken of all requests for PEG placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a PEG was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral. RESULTS: During the period 2005-2008, 198 patients were referred for PEG; 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty-four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4 vs 74.6 , P <0.0001) and 150 days (82.1 vs 57.9 , P = 0.0001) compared with all other patients. Patients who received PEG despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive PEG. CONCLUSION: The application of selection criteria by trained assessors improves patient selection for PEG insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from PEG. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit - in these patients, the procedure may have been fu

UR - http://onlinelibrary.wiley.com/doi/10.1111/imj.12705/epdf

U2 - 10.1111/imj.12705

DO - 10.1111/imj.12705

M3 - Article

VL - 45

SP - 648

EP - 652

JO - Internal Medicine Journal

JF - Internal Medicine Journal

SN - 1444-0903

IS - 6

ER -