Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark.
Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15, 8450, Hammel, Denmark; University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg, Denmark.
Clin Nutr. 2023 Sep;42(9):1770-1777. doi: 10.1016/j.clnu.2023.07.007. Epub 2023 Jul 17.
BACKGROUND & AIMS: Enteral feeding is very common following an acquired brain injury. However, no prognostic models for oral food intake have been developed for subacute rehabilitation. The aim of this study was to develop a prognostic model and online tool, coined "subacute prognosis of oral nutrition" (SPOON), for complete oral intake in tube-fed subjects with acquired brain injury.
The model was developed using routinely gathered clinical data from a cohort of 1233 adult patients who were tube-fed at admission for sub-acute inpatient rehabilitation. Candidate predictors were included based on scientific evidence and their availability in the medical records within the first days following admission. The outcome was time until achieving complete oral food intake without any tube-feeding supplements. Time until complete oral intake was analyzed by discrete time-to-event analysis with logit-link and presented as daily odds ratios (OR) with 95% confidence intervals (CI).
The following predictors of complete oral intake were included in the model: age, diagnosis, cuffed tracheostomy tube, days from injury to admission for rehabilitation, and the Early Functional Abilities (EFA) sum score. Multiple adjusted analyses were performed stratified by cuffed tracheostomy tube status. Some of the strongest predictors of complete oral intake were age 18-40 years, OR 1.99 (95%CI: 1.53; 2.59); 0-2 weeks since injury, OR 3.75 (95%CI: 2.72; 5.16); and EFA 61-100 (slight/no disturbance in function), OR 5.81 (95%CI: 4.47; 7.55). The online prognostic tool SPOON was evaluated in a usability study. Based on feedback from clinicians, the tool was further refined to enable extraction of data for prediction directly from medical records.
The objective of SPOON is to complement the planning of rehabilitation initiatives and inform discussions to determine if a percutaneous endoscopic gastrostomy (PEG) tube should be inserted. SPOON is being implemented locally, but external validation based on appropriate data modeling is warranted before further clinical implementation.
获得性脑损伤后，肠内喂养非常常见。然而，亚急性康复阶段还没有开发出用于预测口腔摄食的预后模型。本研究旨在为接受管饲的获得性脑损伤患者开发一种用于完全经口摄食的预后模型和在线工具，命名为“亚急性口服营养预后”（SPOON）。
该模型使用了 1233 名成人患者的队列中常规收集的临床数据，这些患者在亚急性住院康复治疗期间入院时接受管饲。候选预测因素是基于科学证据并在入院后最初几天的病历中可用而被纳入的。结局是实现完全经口进食而无需任何管饲补充的时间。采用离散时间事件分析，使用对数链接分析完全经口摄入的时间，并以每日优势比（OR）及其 95%置信区间（CI）表示。
该模型纳入了以下完全经口摄入的预测因素：年龄、诊断、带囊气管切开管、从损伤到入院进行康复治疗的天数，以及早期功能能力（EFA）总分。对带囊气管切开管状态进行分层的多因素调整分析。完全经口摄入的一些最强预测因素是年龄 18-40 岁，OR 1.99（95%CI：1.53；2.59）；损伤后 0-2 周，OR 3.75（95%CI：2.72；5.16）；EFA 61-100（功能轻微/无障碍），OR 5.81（95%CI：4.47；7.55）。在线预后工具 SPOON 在一项可用性研究中进行了评估。根据临床医生的反馈，对该工具进行了进一步改进，以便直接从病历中提取数据进行预测。
SPOON 的目的是补充康复计划，并为确定是否应插入经皮内镜下胃造口术（PEG）管提供信息。SPOON 正在当地实施，但在进一步临床实施之前，需要基于适当的数据建模进行外部验证。
