Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial

摘要

The purpose of this study was to assess patient outcomes 90 days after acute stroke following intervention targeted to manage fever, hyperglycemia, and swallowing. The Quality in Acute Stroke Care study was a single-blind, cluster randomized, controlled trial. Nineteen acute stroke units in New South Wales, Australia, were randomly assigned to intervention (n = 10) or control (n = 9). A total of 6,564 patients were assessed for eligibility and data were obtained on 1,696 patients (687 preintervention and 1,009 postintervention). Intervention acute stroke unit patients received treatment protocols to manage fever, hyperglycemia, and swallowing dysfunction through multidisciplinary care building workshops. All clinical protocols were given by bedside nurses. Control acute stroke unit patients received only an abridged version of existing guidelines. Irrespective of stroke severity, intervention acute stroke unit patients were significantly less Likely to be dead or dependent at 90 days than control acute stroke unit patients, i.e., 236/558 (42%) in the intervention group versus 259/449 (58%) in the control group,p = 0.002). Intervention patients also had a better mean physical summary score but no improvement was found in mortality. Nurse-initiated management of fever, hyperglycemia, and dysphagia via evidence-based protocols resulted in improved patient outcomes after discharge from acute stroke units.