Patient selection for pediatric gastrostomy tubes: Are we placing tubes that are not being used?

Infographic · Jun 2022 · 1 min read

In brief

Study of 142 pediatric inpatient gastrostomy tube placements found 15% were used less than 6 months, particularly in adolescents and traumatic brain injury patients. One-third of short-term cases required costly fistula closure operations, suggesting nasogastric tubes may be more appropriate for these populations.

15% of pediatric inpatient gastrostomy tubes were used <6 months, suggesting overutilization in select populations.
Adolescents (≥12 years) and traumatic brain injury patients had significantly higher rates of short-term GT use.
One-third of short-term GT patients required surgical fistula closure, adding morbidity and cost (~$30K in charges).
Consider trial of nasogastric feeding in adolescents and TBI patients before committing to surgical gastrostomy.
Patient selection criteria for GT placement should account for age and injury type to reduce unnecessary procedures.

Written by the GCMD Library team from the infographic.

The infographic uses a red header banner and teal accent colors. It shows a gastrostomy tube illustration on the left, a calendar icon with X marks in the center top, and two human silhouettes at the bottom representing traumatic brain injury patients and adolescents. Gray arrows point from the central statistic to the two patient groups, with odds ratios displayed below each.

Introduction

Identifying pediatric patients who may benefit from gastrostomy tube (GT) placement can be challenging. We hypothesized that many GTs would no longer be in use after 6 months.

Methods

Inpatient GT placements in patients < 18 years old at a tertiary children's hospital from 9/2014 to 2/2020 were included. The primary outcome was GT use <6 months (short-term). Secondary outcomes included age at placement, indication for GT, and operations for GT-related issues.

Results

Fifteen percent (22/142) of GTs were used for <6 months post-operatively. The median duration of short-term GT use was 1.6 months (IQR 0.9–3.4 months). Short-term GTs were more likely to be placed in patients with traumatic brain injury (TBI) (18.2% vs. 4.2%, p = 0.03) and adolescents (≥12 years old, 22.7% vs. 4.0%, p = 0.005). Gastrocutaneous fistula closure was required in 33.3% of short-term patients who had their GTs removed (n = 6/18), with median total hospital charges of $29,989 per patient.

Conclusion

Fifteen percent of pediatric GTs placed as inpatients were used for <6 months, more commonly among adolescents and in TBI patients. One-third of patients with short-term GTs required gastrocutaneous fistula closure. Adolescents and TBI patients may benefit from consideration of short-term nasogastric tube (NGT) feeds rather than surgical GT placement.

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