Evidence-based treatment protocols in acute stroke

January 01, 0001

Evidence-based treatment protocols in acute stroke

The researchers from Australia and Canada assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia, and swallowing dysfunction in acute stroke units (ASUs). In the Quality in Acute Stroke Care (QASC) study, a single-blind cluster randomised controlled trial, the researchers randomised ASUs (clusters) in New South Wales, Australia, with immediate access to CT and on-site high dependency units, to intervention or control group. Patients were eligible if they spoke English, were aged 18 years or older, had had an ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms. 19 ASUs were randomly assigned to intervention (n=10) or control (n=9). Of 6564 assessed for eligibility, 1696 patients' data were obtained (687 pre-intervention; 1009 post- intervention).

Results showed that, irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent (mRS greater than or equal 2) at 90 days than control ASU patients (42% of 558 patients in the intervention group vs 58% of 449 in the control group; number needed to treat 6·4; adjusted absolute difference 15·7%). They also had a better SF-36 mean physical component summary score (45·6 in the intervention group vs 42·5 in the control group; adjusted absolute difference 3·4) but no improvement was recorded in mortality (4% of 558 in intervention group and 5% of 451 in the control group), SF-36 mean mental component summary score (49·5 in the intervention group vs 49·4 in the control group) or functional dependency.

The researchers concluded: "Implementation of multidisciplinary supported evidence-based protocols initiated by nurses for the management of fever, hyperglycaemia, and swallowing dysfunction delivers better patient outcomes after discharge from stroke units. Our findings show the possibility to augment stroke unit care."

Support for nursing, but wasn’t this already obvious. Maybe it is nurses and protocols that is supposed to be the point here … but didn’t they exist? And why the three measurements used here?

For the full abstract, click here.

The Lancet published online 12 October 2011 © 2011 Elsevier Inc
Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Sandy Middleton, Patrick McElduff, Jeanette Ward et al on behalf of the QASC Trialists Group. Correspondence to Sandy Middleton: sandy.middleton@acu.edu.au

Category: N. Neurological Keywords: evidence-based treatment, protocols, manage, fever, hyperglycaemia, swallowing, acute stroke, cluster randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 28 October 2011

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