Mark J. Alberts, MD
Does an intervention targeting management of fever, hyperglycemia, and swallowing dysfunction (FeSS) after acute stroke improve patient outcomes more than access to existing guidelines?
Cluster randomized controlled trial (Quality in Acute Stroke Care [QASC] study). Australia New Zealand Clinical Trial Registry ACTRN12608000563369.
Blinded* (patients, research assistants, and statistician).
90 days after hospital admission.
19 acute stroke units (ASUs) in New South Wales, Australia.
1126 English-speaking patients ≥ 18 years of age (70% ≥ 65 y, 60% men) who had ischemic stroke or intracerebral hemorrhage and presented ≤ 48 hours after symptom onset. Exclusion criteria included admission for palliative care.
FeSS intervention, which included site-based education, support, and multidisciplinary team-building workshops to facilitate implementation of nurse-initiated, evidence-based treatment protocols to manage FeSS for the first 72 hours after ASU admission (n = 10 ASUs, n = 626 patients); or use of abridged existing guidelines (control group n = 9, ASUs n = 500 patients).
Included a composite of death or dependency (dependency = modified Rankin scale score ≥ 2), functional dependency (Barthel index), and physical health (PCS) and mental functioning (MCS) subscales of the SF-36 scale. Analyses were adjusted for clustering within ASUs and baseline data from a separate preintervention cohort (n = 735).
100% of ASUs and 90% of patients (intention-to-treat analysis).
Results for the composite outcome are in the Table. Patients in the FeSS group had improved physical health (mean PCS score 46 vs 43, P = 0.002) compared with those in the control group; groups did not differ for mental functioning (mean MCS score 49.5 vs 49.4, P = 0.69) or functional dependency (proportion with Barthel index ≥ 60, 92% vs 90%, P = 0.44).
A multidisciplinary intervention targeting management of fever, hyperglycemia, and swallowing dysfunction reduced death or dependency at 90 days in patients in acute stroke units.
†ASU = acute stroke unit; FeSS = fever, sugar, and swallowing; other abbreviations defined in Glossary. RRR and CI provided by author; NNT and CI calculated from absolute difference reported in the article.
‡Adjusted for baseline data and ASU clustering.
§Death (4% vs 5%, P = 0.36); dependency = modified Rankin scale score ≥ 2 (data not reported).
Alberts MJ. Targeting management of fever, hyperglycemia, and swallowing improved outcomes in acute stroke. Ann Intern Med. ;156:JC3–9. doi: 10.7326/0003-4819-156-6-201202210-02009
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Published: Ann Intern Med. 2012;156(6):JC3-9.
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