CoChat
Sign Up
Cited by 56Dysphagia Assessment and ManagementClinical Nutrition and GastroenterologyChild Nutrition and Feeding Issues

Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial

Open access
Beavan, J., Conroy, S. P., Harwood, R., Gladman, J. R. F., Leonardi-Bee, J., Sach, T., Bowling, T., Sunman, W. +1 more·2010·Age and Ageing
DOI 10.1093/ageing/afq088
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: nasogastric tube (NGT) feeding is commonly used after stroke, but its effectiveness is limited by frequent dislodgement. OBJECTIVE: the objective of the study was to evaluate looped NGT feeding in acute stroke patients with dysphagia. METHODS: this was a randomised controlled trial of 104 patients with acute stroke fed by NGT in three UK stroke units. NGT was secured using either a nasal loop (n = 51) or a conventional adhesive dressing (n = 53). The main outcome measure was the proportion of prescribed feed and fluids delivered via NGT in 2 weeks post-randomisation. Secondary outcomes were frequency of NGT insertions, treatment failure, tolerability, adverse events and costs at 2 weeks; mortality; length of hospital stay; residential status; and Barthel Index at 3 months. RESULTS: participants assigned to looped NGT feeding received a mean 17% (95% confidence interval 5-28%) more volume of feed and fluids, required fewer NGTs (median 1 vs 4), and had fewer electrolyte abnormalities than controls. There was more minor nasal trauma in the loop group. There were no differences in outcomes at 3 months. Looped NGT feeding cost 88 pounds sterling more per patient over 2 weeks than controls. CONCLUSION: looped NGT feeding improves delivery of feed and fluids and reduces NGT reinsertion with little additional cost.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/ageing/afq088

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A RCT observed an increase of 17% mean volume of fluid and tube feed given in the nasal loop group, without any differences in outcome after three months.

    “A RCT observed an increase of 17% mean volume of fluid and tube feed given in the nasal loop group, without any differences in outcome after three months (169).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [169]

    The Results (page not available in our copy) report that the nasal-loop group received a 17-percentage-point higher proportion of prescribed feed and fluids, not a 17% increase in mean volume; mean volumes were 17.0 L versus 11.4 L. The Results describe three-month outcomes as similarly poor, and Table 2 shows no statistically significant differences in the three-month outcomes reported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Two studies on nasal loops in tube-fed stroke patients demonstrated that nasal loops are safe, well-tolerated and effective in delivering full enteral nutrition.

    “Two studies on nasal loops in tube-fed stroke patients demonstrated that nasal loops are safe, well-tolerated and effective in delivering full EN (167-169).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [169]

    The Discussion reports that nasal loops increased delivery of prescribed feed and fluids from 57% to 75%, not that they delivered full enteral nutrition. The Results report no significant difference in measured tolerability, but minor nasal problems were more common with loops (37% versus 15%); none required medical intervention. These findings support improved delivery and some reassurance about tolerability, but not the unqualified claims of full delivery and safety. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 24

  1. Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil 1995; 76: 1130-3.
  2. Gariballa SE, Parker SG, Taub N, Castleden CM. A randomised, controlled, single blind trial of nutritional supplementation in stroke. JPEN 1998; 22: 315-9.
  3. Smithard DG, O'Neill P, England RE et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12: 188-93.
  4. Mann G, Hankey G. Initial clinical and demographic predic- tors of swallowing impairment following acute stroke. Dysphagia 2000; 16: 208-15.
  5. Elia M, S. R, Holden C et al. Committee of the British Artificial Nutrition Survey (BANS). Home enteral feeding after cerebro- vascular accident. Clin Nutr 2001; 20: 27-30.
  6. Crary MA, Carnaby-Mann G, Miller L, Antomius N, Silliman S. Dysphagia and nutritional status at the time of hospital ad- mission for ischaemic stroke. J Stroke Cerebrovasc Dis 2006; 15: 164-71.
  7. Perry L. Eating and dietary intake in communication impaired stroke survivors: a cohort study from acute stage hospital admis- sion to 6 months post-stroke. Clin Nutr 2004; 23: 1333-43.
  8. Smithard DG, Smeeton NC, Wolfe CDA. Long term out- come after stroke: does dysphagia matter? Age Ageing 2007; 36: 90-4.
  9. Martineau J, Bauer JD, Isenring E, Cohen S. Malnutrition deter- mined by the patient generated SGA is associated with poor outcomes in acute stroke patients. Clin Nutr 2005; 24: 1073-7.
  10. The FOOD Trial Collaboration. Routine oral nutritional sup- plementation for stroke patients in hospital (FOOD): a multicentre randomised trial. Lancet 2005; 365: 755-63.
  11. Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP. Intensive nutritional supplements can improve outcomes in stroke re- habilitation. Neurology 2008; 71: 1856-61.
  12. Abernathy GB, Heizer WD, Holcombe BJ, Raasch RH, Sclegelke LJ. Efficacy of tube feeding in supplying energy requirements of hospitalised patients. JPEN 4; 13: 387-91.
  13. Briggs D. Nasogastric tube feeding practice in intensive care units. Nurs Stand 1996; 10: 42-5.
  14. Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GK. A randomised controlled trail of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996; 312: 13-6.
  15. Popovich M, Lockrem J, Zivot J. Nasal Bridle revisited: an im- provement in the technique to prevent unintentional removal of small bore nasoenteric feeding tubes. Crit Care Med 1996; 24: 429-31.
  16. Anderson M, O'Connor M, Mayer P et al. The nasal loop pro- vides an alternative to percutaneous endoscopic gastrostomy in high risk dysphagic patients. Clin Nutr 2004; 23: 501-6.
  17. McCullough GH, Wertz RT, Rosenbek JC. Sensitivity and spe- cificity of clinical bedside examination signs for detecting aspiration in adults subsequent for stroke. J Commun Disord 2001; 43: 55-72.
  18. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 337: 1521-6.
  19. Beavan JR, Conroy S, Leonardi-Bee J et al. Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke? Trials 2007; 8: 19.
  20. Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol 1997; 50: 693-703.
  21. Donaldson E, Earley T, Shields PL. The nasal bridle-its place within an integrated nutrition service: a prospective audit of one year's data (abstract no. 420). Gut 2007; 56: A137.
  22. Johnston RD, O'Dell L, Patrick M, Cole AT, Cunliffe RN. Outcome of patients fed via a nasogastric tube retained with a bridle loop: do bridle loops reduce the requirement for percutaneous endoscopic gastrostomy insertion and 30 day mortality. Proc Nutr Soc 2008; 67: e116. doi:10.1017/ S0029665108007489. · DOI
  23. Caro JJ, Huybrechts KF. Stroke treatment economic model (STEM): predicting long-term costs from functional status. Stroke 1999; 30: 2574-9.
  24. Dewey HM, Thrift AG, Mihalopoulos C et al. Lifetime costs of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004; 34: 2502-7.

Cited by

Sorted by citations

Authors
Beavan, J., Conroy, S. P., Harwood, R., Gladman, J. R. F., Leonardi-Bee, J., Sach, T., Bowling, T., Sunman, W., & Gaynor, C.
Affiliations
  • Royal Derby Hospital (GB)
  • University of Leicester (GB)
  • Nottingham University Hospitals NHS Trust (GB)
  • University of Nottingham (GB)
  • University of East Anglia (GB)
  • Queen's Medical Centre (GB)
Corresponding author
Beavan, J.
ORCID
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2010-07-27
Volume
39
Issue
5
Pages
624-630
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afq088
OpenAlex
W2138975123
Cited by
56
References
0
Citations by year
2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 6 · 2017: 5 · 2015: 7 · 2014: 3 · 2013: 7 · 2012: 3
FWCI
9.76
Type
journal article
Language
en
Open access
Locations
  • Age and Ageing (publishedVersion)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by-nc)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
nasogastric tube feeding, dysphagia, acute stroke, enteral nutrition, tube dislodgement, electrolyte imbalance, nasal trauma, feed cost, stroke rehabilitation
MeSH terms
Stroke Rehabilitation, Acute Disease, Aged, Aged, 80 and over, Aging, Bandages, Deglutition Disorders, Enteral Nutrition, Female, Humans, Intubation, Gastrointestinal, Length of Stay, Male, Nutrition Disorders, Treatment Outcome, Health Care Costs, Stroke

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review