Multidisciplinary Intervention Ups Outcomes in Acute Stroke

Management of hyperglycemia, fever, swallowing dysfunction cuts death/dependency at 90 days

WEDNESDAY, Oct. 12 (HealthDay News) -- Stroke patients who receive a multidisciplinary intervention targeting management of fever, hyperglycemia, and swallowing dysfunction are less likely to be dead or dependent at 90 days and more likely to have better physical functioning, according to a study published online Oct. 12 in The Lancet.

Sandy Middleton, Ph.D., from the Australian Catholic University in Sydney, and colleagues investigated the impact of a multidisciplinary intervention with an evidence-based treatment protocol to manage fever, hyperglycemia, and swallowing dysfunction on patient outcomes at 90 days after hospitalization for stroke. English speaking patients, aged 18 years or older, presenting within 48 hours of onset of symptoms and diagnosed with ischemic stroke or intracerebral hemorrhage were included. Ten acute stroke units (ASUs) were randomized to receive the intervention and nine to receive an abridged version of existing guidelines (control). Data from pre-intervention and post-intervention patient cohorts were compared for 90-day death or dependency (modified Rankin scale [mRS], ≥2), functional dependency, and short form-36 (SF-36) physical and mental component summary scores.

The investigators found that irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent at 90 days than the control group (42 versus 58 percent).The SF-36 mean physical component summary score was significantly better in the intervention than the control group (45.6 versus 42.5). There were no significant differences between the groups for mortality, SF-36 mean mental component summary scores, or functional dependency.

"Implementation of multidisciplinary supported evidence-based protocols initiated by nurses for the management of fever, hyperglycemia, and swallowing dysfunction delivers better patient outcomes after discharge from stroke units," the authors write.

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