Abstract
Background: Fever, hyperglycemia, and swallow dysfunction poststroke are associated with significantly worse outcomes. We report treatment and monitoring practices for these three items from a cohort of acute stroke patients prior to randomization in the Quality in Acute Stroke Care trial. Method: Retrospective medical record audits were undertaken for prospective patients from 19 stroke units. For the first three-days following stroke, we recorded all temperature readings and administration of paracetamol for fever (≥37÷5ðC) and all glucose readings and administration of insulin for hyperglycemia (>11mmol/L). We also recorded swallow screening and assessment during the first 24h of admission. Results: Data for 718 (98%) patients were available; 138 (19%) had four hourly or more temperature readings and 204 patients (29%) had a fever, with 44 (22%) receiving paracetamol. A quarter of patients (n=102/412, 25%) had six hourly or more glucose readings and 23% (95/412) had hyperglycemia, with 31% (29/95) of these treated with insulin. The majority of patients received a swallow assessment (n=562, 78%) by a speech pathologist in the first instance rather than a swallow screen by a nonspeech pathologist (n=156, 22%). Of those who passed a screen (n=108 of 156, 69%), 68% (n=73) were reassessed by a speech pathologist and 97% (n=71) were reconfirmed to be able to swallow safely. Conclusions: Our results showed that acute stroke patients were: undermonitored and undertreated for fever and hyperglycemia; and underscreened for swallowing dysfunction and unnecessarily reassessed by a speech pathologist, indicating the need for urgent behavior change.
Original language | English |
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Pages (from-to) | 23-31 |
Number of pages | 9 |
Journal | International Journal of Stroke |
Volume | 9 |
Issue number | 1 |
DOIs | |
Publication status | Published - 2014 |
Keywords
- fever
- hyperglycemia
- insulin
- paracetamol
- stroke
- swallow screens