Vital sign monitoring following stroke associated with 90-day independence: A secondary analysis of the QASC cluster randomized trial

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dc.contributor.authorMiddleton, Sandy
dc.contributor.authorMcElDuff, Patrick
dc.contributor.authorDrury, Peta
dc.contributor.authorD'Este, Catherine
dc.contributor.authorCadilhac, Dominique
dc.contributor.authorDale, Simeon
dc.contributor.authorGrimshaw, Jeremy M
dc.contributor.authorWard, Jeanette
dc.contributor.authorQuinn, Clare
dc.contributor.authorCheung, N Wah
dc.contributor.authorLevi, Christopher
dc.date.accessioned2019-11-25T02:02:37Z
dc.date.issued2019
dc.date.updated2019-05-19T08:20:51Z
dc.description.abstractBackground The Quality in Acute Stroke Care Trial implemented nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (Fever, Sugar, Swallow clinical protocols) achieving a 16% absolute improvement in death and dependency 90-day post-stroke. Objective To examine associations between 90-day death and dependency, and monitoring and treatment processes of in-hospital nursing stroke care targeted in the trial. Design Secondary data analysis from a single-blind cluster randomised control trial. Setting 19 acute stroke units in New South Wales, Australia. Participants English-speakers ≥18 years with ischaemic stroke or intracerebral haemorrhage arriving at participating stroke units <48 h of stroke onset, excluding those for palliation and without a telephone. Method Data from patients in the 10 intervention hospitals and the nine control hospitals in the QASC trial post-intervention cohort, who had both hospital process of care data and 90-day outcome data were included. Associations between independence at 90-day (modified Rankin Score ≤1) and processes of care for fever, hyperglycaemia, and dysphagia screening were examined using multiple logistic regression adjusting for treatment group, sex, age group, premorbid modified Rankin scale, marital status, education, stroke severity and correlation within hospitals. Results Of 1126 patients in the post-intervention cohort (intervention or control), 970 had both in-hospital processes of care data and 90-day outcome data. Patients had significantly lower odds of 90-day independence if, within the first 72 h of stroke unit admission, they had one or more: febrile event (≥37.5 °C) (OR 0.47; 95%CI:0.35-0.61; P < 0.0001), higher mean temperature (OR:0.25; 95%CI:0.14-0.45; P < 0.0001), finger-prick blood glucose reading ≥11 mmol/L (OR:0.61; 95%CI:0.47-0.79; P = 0.0002), higher mean blood glucose (OR 0.89; 95%CI:0.84-0.95; P = 0.0006), or failed the swallowing screen (OR 0.35; 95%CI:0.22-0.56; P < 0.0001). Patients had greater odds of independence when: venous blood glucose was taken on admission to hospital or within 2 h of stroke unit admission (OR 1.4; 95%CI:1.01–1.83; P = 0.04); finger-prick blood glucose was measured within 72 h of stroke unit admission (OR 1.3; 95%CI:1.02-1.55; P = 0.03); or when swallowing screening or assessment was performed within 24 h of stroke unit admission (OR 1.8; 95%CI:1.29-2.55; P = 0.0006). Conclusion We have provided robust evidence of the importance of monitoring patients’ temperature, blood glucose and swallowing status to improve 90-day stroke outcomes. Routine nursing care can result in significant reduction in death and dependency post-stroke.en_AU
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn0020-7489en_AU
dc.identifier.urihttp://hdl.handle.net/1885/186563
dc.language.isoen_AUen_AU
dc.publisherPergamon Press Ltd.en_AU
dc.rights© 2018 Elsevier Ltden_AU
dc.sourceInternational Journal of Nursing Studiesen_AU
dc.titleVital sign monitoring following stroke associated with 90-day independence: A secondary analysis of the QASC cluster randomized trialen_AU
dc.typeJournal articleen_AU
local.bibliographicCitation.lastpage79en_AU
local.bibliographicCitation.startpage72en_AU
local.contributor.affiliationMiddleton, Sandy, Australian Catholic Universityen_AU
local.contributor.affiliationMcElDuff, Patrick, University of Newcastleen_AU
local.contributor.affiliationDrury, Peta, Australian Catholic Universityen_AU
local.contributor.affiliationD'Este, Catherine, College of Health and Medicine, ANUen_AU
local.contributor.affiliationCadilhac, Dominique, Monash Universityen_AU
local.contributor.affiliationDale, Simeon, Australian Catholic Universityen_AU
local.contributor.affiliationGrimshaw, Jeremy M, University of Ottawaen_AU
local.contributor.affiliationWard , Jeanette, University of Notre Dame, Broom Campus, Broome, Western Australia, Australiaen_AU
local.contributor.affiliationQuinn, Clare, Prince of Wales Hospitalen_AU
local.contributor.affiliationCheung, N Wah, University of Sydneyen_AU
local.contributor.affiliationLevi, Christopher, University of Newcastleen_AU
local.contributor.authoremailu5460340@anu.edu.auen_AU
local.contributor.authoruidD'Este, Catherine, u5460340en_AU
local.description.embargo2037-12-31
local.description.notesImported from ARIESen_AU
local.identifier.absfor111711 - Health Information Systems (incl. Surveillance)en_AU
local.identifier.absseo920204 - Evaluation of Health Outcomesen_AU
local.identifier.ariespublicationu3102795xPUB374en_AU
local.identifier.citationvolume89en_AU
local.identifier.doi10.1016/j.ijnurstu.2018.09.014en_AU
local.identifier.scopusID2-s2.0-85055126484
local.identifier.uidSubmittedByu3102795en_AU
local.publisher.urlhttps://www.elsevier.com/en-auen_AU
local.type.statusPublished Versionen_AU

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