Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia. Issue 1 (10th November 2013)

• Record Type: Journal Article
• Authors: Drury, Peta; Levi, Christopher; McInnes, Elizabeth; Hardy, Jennifer; Ward, Jeanette; Grimshaw, Jeremy M.; D' Este, Catherine; Dale, Simeon; McElduff, Patrick; Cheung, N Wah; Quinn, Clare; Griffiths, Rhonda; Evans, Malcolm; Cadilhac, Dominique; Middleton, Sandy
• Is Part Of: International journal of stroke. Volume 9:Issue 1(2014:Jan.)
• Page Start: 23
• Page End: 31
• Publication Date: 2013-11-10
• Subjects: 616.8005
• DOI: 10.1111/ijs.12194
• Languages: English
• ISSNs: 1747-4930

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ijs12194-sec-0001" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="ijs12194-sec-0002" sec-type="section"> <title>Method</title> <p>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 (≥37·5°C) and all glucose readings and administration of insulin for hyperglycemia (>11 mmol/L). We also recorded swallow screening and assessment during the first 24 h of admission.</p> </sec> <sec id="ijs12194-sec-0003" sec-type="section"> <title>Results</title> <p>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 (<italic>n</italic> = 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 (<italic>n</italic> = 562, 78%) by a speech pathologist in the first instance rather than a swallow screen by a nonspeech pathologist (<italic>n</italic> = 156, 22%). Of those who passed a screen (<italic>n</italic> = 108 of 156, 69%), 68% (<italic>n</italic> = 73) were reassessed by a speech pathologist and 97% (<italic>n</italic> = 71) were reconfirmed to be able to swallow safely.</p> </sec> <sec id="ijs12194-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>