Supplementary Material for: Impact of nasal bridles on nasogastric tube dislodgement and nutritional adequacy in acute stroke patients – a pre-post study.

Introduction: Nasogastric tube (NET) dislodgement is common in dysphagic stroke patients, impacting nutritional adequacy and health resourcing. Nasal bridles can reduce dislodgement risk, but their routine use following acute stroke has not been rigorously evaluated. We assessed whether routine nasal bridle use reduces NET dislodgements and its impact. Methods: A single-centre pre-post observational study in stroke patients receiving a NET involved: 6-month baseline period (pre); and routine nasal bridle insertion (post). NET dislodgements (primary outcome) and enteral nutrition (EN) adequacy in the pre and post groups were compared using negative binomial and ordered beta regression models, respectively, adjusted for patient and stroke characteristics. Data are mean±standard deviation and adjusted rate ratios (aRR) with 95% confidence interval (CI). Results: 119 patients (70 pre, 49 post) were enrolled (median [interquartile range] 78 [70-84] vs 79 [73-86] years; male 46% vs 61%; National Institute of Health Stroke Scale scores 13 [8-21] vs 14 [10-21]. NET dislodgements were significantly lower in the post group (Mean±SD 1.8±1.7 pre vs 1.6±2.1 post; aRR 0.624 (95% CI 0.41-0.92; p=0.019)) and with bridle (1.7±1.6 no bridle vs 1.1±1.7 bridle; aRR 0.52 (95% CI 0.35-0.79; p=0.002)). EN adequacy was higher in the post group (77.0% pre vs 91.5% post) and those with a bridle (84.2% no bridle vs 96.9% bridle). Conclusion: Routine nasal bridle insertions following stroke may reduce NET dislodgement frequency and improve nutritional adequacy, yet this requires confirmation in a prospective randomised trial.