Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia

Authors

  • Peta Drury,

    1. Nursing Research Institute, St. Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia
    2. School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, NSW, Australia
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  • Christopher Levi,

    1. Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
    2. Priority Centre for Brain & Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
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  • Elizabeth McInnes,

    1. Nursing Research Institute, St. Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia
    2. School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, NSW, Australia
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  • Jennifer Hardy,

    1. Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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  • Jeanette Ward,

    1. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
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  • Jeremy M. Grimshaw,

    1. Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
    2. Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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  • Catherine D' Este,

    1. Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Newcastle, NSW, Australia
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  • Simeon Dale,

    1. Nursing Research Institute, St. Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia
    2. School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, NSW, Australia
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  • Patrick McElduff,

    1. Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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  • N Wah Cheung,

    1. Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
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  • Clare Quinn,

    1. Speech Pathology Department, Prince of Wales Hospital, Sydney, NSW, Australia
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  • Rhonda Griffiths,

    1. School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia
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  • Malcolm Evans,

    1. Priority Centre for Brain & Mental Health Research, University of Newcastle, Newcastle, NSW, Australia
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  • Dominique Cadilhac,

    1. Translational Public Health, Stroke and Ageing Research Centre, Monash Medical Centre, Southern Clinical School, Monash University, Melbourne, Vic., Australia
    2. National Stroke Research Institute, Florey Neuroscience Institutes, Melbourne Brain Centre, St. Heidelberg, Vic., Australia
    3. University of Melbourne, Melbourne, Vic., Australia
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  • Sandy Middleton

    Corresponding author
    1. Nursing Research Institute, St. Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia
    2. School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, NSW, Australia
    • Correspondence: Sandy Middleton, Nursing Research Institute, St. Vincent's Hospital, Level 5, deLacy Building, 379 Victoria Street, Darlinghurst, NSW 2010, Australia.

      E-mail: sandy.middleton@acu.edu.au

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  • Conflicts of interests: None declared.
  • Trial Registration: Australia New Zealand Clinical Trial Registry (ANZCTR) No: ACTRN12608000563369.
  • For the protocols and information about the intervention, see http://www.acu.edu.au/qasc
  • Conflict of interest: None declared.

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 (≥37·5°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.

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