{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:28:04Z","timestamp":1789608484106,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,6,8]],"date-time":"2015-06-08T00:00:00Z","timestamp":1433721600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Percutaneous endoscopic gastrostomy (<jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content>) placement is performed in a patient group with high mortality in the short and medium term. For a significant proportion of patients, the procedure provides no increase in survival. There are no standardised assessment tools available to determine the clinical appropriateness of <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> placement, nor any to predict clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The study aims to determine whether clinical assessment, by a trained dietitian, of the appropriateness of <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> placement is predictive of mortality in the short and medium terms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective audit was undertaken of all requests for <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> placement at a single large, publicly funded Australian tertiary hospital. The clinical appropriateness of each request was assessed by a trained dietitian, and data on age, sex, reason for referral, comorbidities and satisfaction of assessment criteria were collected, and patient outcome and survival were compared for all patients according to whether a <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> was inserted or not. Main outcome measures were mortality at 30 and 150 days after referral.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the period 2005\u20132008, 198 patients were referred for <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content>; 94 were assessed as appropriate referrals, 104 as inappropriate. Eighty\u2010four patients who underwent gastrostomy, after being assessed as appropriate, had significantly reduced mortality at 30 days (96.4% vs 74.6%, <jats:italic>P<\/jats:italic> &lt; 0.0001) and 150 days (82.1% vs 57.9%, <jats:italic>P =<\/jats:italic> 0.0001) compared with all other patients. Patients who received <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> despite contrary advice had no significant survival advantage, at 30 days or 150 days, over patients who did not receive <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The application of selection criteria by trained assessors improves patient selection for <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content> insertion and predicts mortality at early and later time points, by identifying patients unlikely to benefit from <jats:styled-content style=\"fixed-case\">PEG<\/jats:styled-content>. The group of patients who received a gastrostomy despite an adverse assessment had no mortality benefit \u2013 in these patients, the procedure may have been futile.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.12705","type":"journal-article","created":{"date-parts":[[2015,2,3]],"date-time":"2015-02-03T03:33:31Z","timestamp":1422934411000},"page":"648-652","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical selection criteria can predict futile intervention in patients referred for percutaneous endoscopic gastrostomy insertion"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7752-6279","authenticated-orcid":false,"given":"D. Q.","family":"Holt","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Unit Monash Health  Melbourne Australia"},{"name":"Clinical Nutrition and Metabolism Unit Monash Health  Melbourne Australia"},{"name":"Department of Medicine, School of Clinical Sciences Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. F.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Metabolism Unit Monash Health  Melbourne Australia"},{"name":"PEG Outreach Service Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. L.","family":"Murray","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Metabolism Unit Monash Health  Melbourne Australia"},{"name":"PEG Outreach Service Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Hair","sequence":"additional","affiliation":[{"name":"School of Medicine Deakin University  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. A.","family":"Devonshire","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. J.","family":"Strauss","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Metabolism Unit Monash Health  Melbourne Australia"},{"name":"Department of Medicine, School of Clinical Sciences Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. T.","family":"Moore","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit Monash Health  Melbourne Australia"},{"name":"Department of Medicine, School of Clinical Sciences Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2005.06.013"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.suppl_7.vii1"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(80)80296-X"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/55.12.M735"},{"key":"e_1_2_7_6_1","first-page":"1","volume-title":"Scoping Our Practice","author":"Cullinane M","year":"2004"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2007.10.019"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1054\/clnu.2002.0563"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.05778.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.02079.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.09.012"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607110376197"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.06.043"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1997.00012.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2011.619278"},{"issue":"1","key":"e_1_2_7_17_1","first-page":"A40","article-title":"Two year audit on percutaneous endoscopic gastrostomy: is the nutrition support team generating more work?","volume":"48","author":"Ng D","year":"2001","journal-title":"Gut"},{"key":"e_1_2_7_18_1","first-page":"1","volume-title":"Clinical Guidelines for Stroke Management 2010","author":"National Stroke Foundation","year":"2010"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)17983-5"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fimj.12705","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.12705","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T17:13:39Z","timestamp":1695489219000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.12705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2015,6]]}},"alternative-id":["10.1111\/imj.12705"],"URL":"https:\/\/doi.org\/10.1111\/imj.12705","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6]]},"assertion":[{"value":"2014-10-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-01-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}