- Title
- Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia
- Creator
- Drury, Peta; Levi, Christopher; Quinn, Clare; Griffiths, Rhonda; Evans, Malcolm; Cadilhac, Dominique; Middleton, Sandy; McInnes, Elizabeth; Hardy, Jennifer; Ward, Jeanette; Grimshaw, Jeremy M.; D' Este, Catherine; Dale, Simeon; McElduff, Patrick; Cheung, N. Wah
- Relation
- NHMRC.353803
- Relation
- International Journal of Stroke Vol. 9, Issue 1, p. 23-31
- Publisher Link
- http://dx.doi.org/10.1111/ijs.12194
- Publisher
- Sage
- Resource Type
- journal article
- Date
- 2014
- Description
- 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 (≥37·5°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. 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.
- Subject
- fever; hyperglycemia; insulin; paracetamol; stroke; swallow screen
- Identifier
- http://hdl.handle.net/1959.13/1307226
- Identifier
- uon:21364
- Identifier
- ISSN:1747-4930
- Language
- eng
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