Impact of an institution-designed algorithm for the management of dislodged gastrostomy tubes
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Read the article on jpedsurg.org ↗Article · Dec 2020 · 1 min read
In brief
In brief
Retrospective study of 433 ED visits for dislodged gastrostomy tubes found that an institutional algorithm was feasible and increased surgical involvement, though it did not significantly reduce contrast studies or reoperations. The algorithm proved safe and effective for managing this common pediatric emergency.
Written by the GCMD Library team from the article.
Abstract
Background
Gastrostomy tube (GT) dislodgement is a common reason for emergency department (ED) visits. We aim to assess the efficacy of our institution's algorithm in reducing surgical consultation and GT contrast studies for replacement of dislodged GT and to examine the need for operation before and after algorithm implementation.
Methods
A retrospective review was performed between March 2017-February 2018 (prealgorithm) and March 2018-December 2018 (postalgorithm) for patients <18 years presenting to the ED with GT dislodgement. Demographics and outcomes were analyzed.
Results
A total of 433 visits among 279 patients were included, 200 (46.2%) pre and 233 (53.8%) postalgorithm implementation. Median ED LOS was 2.1 h (IQR 1.4, 3.0). Surgery was consulted in 92 visits (21.3%) and a contrast study obtained in 287 (66.3%). The GT was replaced by ED providers in 363 visits (83.8%) and by surgery in 70 (16.2%). Surgical consultation increased postalgorithm (16.5% vs. 25.3%; p = 0.03). Six (1.4%) patients required reoperation, with 5 occurring postalgorithm, p = 0.22. For GTs placed < 8 weeks prior to the dislodgment, there were no differences in surgical consultations, contrast studies performed, or need for reoperation pre and postalgorithm.
Conclusion
An algorithm for replacement of dislodged GT is usable, effective, and increased surgical team involvement without significant changes in patient outcomes.
Type of Study
Treatment Study.
Level of Evidence
Level III.