Evidence map›Paper›PMID 27566745›Full record

Trial reportNeurology2016

Association between nasogastric tubes, pneumonia, and clinical outcomes in acute stroke patients.

Lalit Kalra, John Hodsoll, Saddif Irshad, David Smithard, Dulka Manawadu, STROKE-INF Investigators

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
4.3field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.

  1. Pooled it
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  14. Dysphagia Management and Stroke Units.Current physical medicine and rehabilitation reports · 2016
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Lalit KalraFrom the Department of Basic and Clinical Neurosciences (L.K., S.I.), Institute of Psychiatry, Psychology and Neurosciences, and Biostatistics Department (J.H.), NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; University of Kent (D.S.), Canterbury, UK; and King's College Hospital NHS Foundation Trust, London, UK (D.M.). lalit.kalra@kcl.ac.uk.
John HodsollFrom the Department of Basic and Clinical Neurosciences (L.K., S.I.), Institute of Psychiatry, Psychology and Neurosciences, and Biostatistics Department (J.H.), NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; University of Kent (D.S.), Canterbury, UK; and King's College Hospital NHS Foundation Trust, London, UK (D.M.).
Saddif IrshadFrom the Department of Basic and Clinical Neurosciences (L.K., S.I.), Institute of Psychiatry, Psychology and Neurosciences, and Biostatistics Department (J.H.), NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; University of Kent (D.S.), Canterbury, UK; and King's College Hospital NHS Foundation Trust, London, UK (D.M.).
David SmithardFrom the Department of Basic and Clinical Neurosciences (L.K., S.I.), Institute of Psychiatry, Psychology and Neurosciences, and Biostatistics Department (J.H.), NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; University of Kent (D.S.), Canterbury, UK; and King's College Hospital NHS Foundation Trust, London, UK (D.M.).
Dulka ManawaduFrom the Department of Basic and Clinical Neurosciences (L.K., S.I.), Institute of Psychiatry, Psychology and Neurosciences, and Biostatistics Department (J.H.), NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; University of Kent (D.S.), Canterbury, UK; and King's College Hospital NHS Foundation Trust, London, UK (D.M.).
STROKE-INF Investigators
University of Kent · GB

Funding

Department of Health PB-PG-0906-11103
6 · The paper itself

Abstract

objectiveTo investigate whether nasogastric tubes (NGTs) increase poststroke pneumonia (PSP), mortality, or poor outcomes in nil-by-mouth acute stroke patients.

methodsThis study analyzed prespecified outcomes of PSP at 14 days and mortality and function measured by the modified Rankin Scale at 90 days in 1,217 nil-by-mouth stroke patients at ≤48 hours of symptom onset in a multicenter randomized controlled trial of preventive antibiotics between April 21, 2008, and May 17, 2014. Generalized mixed models adjusted for age, comorbidities, stroke type and severity, and quality of care were used. No patients were lost to follow-up at 14 days, and 36 (3%) were lost at 90 days.

resultsPatients with NGT (298 of 1,217 [24.4%]) had more severe strokes (median NIH Stroke Scale score 17 vs 14, p = 0.0001) and impaired consciousness (39% vs 28%, p = 0.001). NGT did not increase PSP (43 of 298 [14.4%] vs 80 of 790 [10.1%], adjusted odds ratio [OR] 1.26 [95% confidence interval (CI) 0.78-2.03], p = 0.35) or 14- and 90-day mortality (33 of 298 [11.1%] vs 78 of 790 [9.9%], adjusted OR 1.10 [95% CI 0.67-1.78], p = 0.71; and 79 of 298 [26.5%] vs 152 of 790 [19.2%], adjusted OR 0.95 [95% CI 0.67-1.33], p = 0.75, respectively). Ninety-day modified Rankin Scale score distribution was comparable between groups (adjusted OR 1.14 [95% CI 0.87-1.56], p = 0.08). PSP independently increased 90-day mortality (40 of 123 [32.5%] vs 191 of 965 [19.8%], adjusted OR 1.71 [95% CI 1.11-2.65], p = 0.015) and was not prevented by antibiotics in patients with NGT (adjusted OR 1.1 [95% CI 0.89-1.54], p = 0.16).

conclusionsEarly NGT does not increase PSP incidence, mortality, or poor functional outcomes and can be used safely in acute stroke patients.

Indexed as

Intubation, GastrointestinalAgedAnti-Bacterial AgentsBrain IschemiaComorbidityFemaleFollow-Up StudiesHumansIncidenceIntracranial HemorrhagesMalePneumoniaSeverity of Illness IndexStrokeTreatment OutcomeUnited KingdomAnti-Bacterial Agents

Identifiers

PMID27566745
PMCPMC5047037
OpenAlexW2511408757

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.