None listed
Conditions
Brief summary
The QASC study developed and trialed a multidisciplinary team building intervention to improve management of fever, raised blood glucose levels and swallowing difficulties in patients following acute stroke. We randomised 19 acute stroke units in NSW, Australia to the intervention (n=10) or control (n=9) group and patient data was obtained from 1696 participants. Results of the trial showed that patients cared for in intervention stroke units were significantly less likely to be dead or dependent 90-days following admission to the stroke unit (p = 0.002; NNT = 6.4; adjusted absolute difference = 15.7% (95% CI 5.8 – 25.4)). These patients also had improved mean SF-36 physical health component summary score (45.6 (SD 10.2)) compared to those in the control group (42.5 (SD 10.5), p = 002). No improvements were noted in the mean SF-36 mental component score (49.5 (SD 10.9) vs. 49.4 (SD 10.6); p = 0.69). There no were no statistically significance in levels of functional dependency between the two groups as measured a Barthel Index score > 60 (92% vs 90%; p = 0.44). The study protocols for management of fever, hyperglycaemia and swallowing; and the implementation strategy are available at www.acu.edu.au/QASC.
Interventions
Evidence-based clinical treatment protocols developed by a panel of clinical experts to guide multidisciplinary clinical care in the management of acute stroke patients with fever, hyperglycaemia and swallowing dysfunction; two one-hour multidisciplinary on-site workshops to be held at conclusion of baseline data collection attended by doctors, nurses and speech pathologists where the clinical protocols will be explained with the aim of determining local barriers and facilitators to clinical pro
Evidence-based clinical treatment protocols developed by a panel of clinical experts to guide multidisciplinary clinical care in the management of acute stroke patients with fever, hyperglycaemia and swallowing dysfunction; two one-hour multidisciplinary on-site workshops to be held at conclusion of baseline data collection attended by doctors, nurses and speech pathologists where the clinical protocols will be explained with the aim of determining local barriers and facilitators to clinical protocol implementation; unit-based education and support provided to the stroke co-ordinator of participating acute stroke units to champion implementation of clinical protocols; longitudinal engagement through support and feedback at local sites. The intervention will be provided for 12 to 18 months dependent on achieving sample size required.
Sponsors
Professor Sandy Middleton
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
English-speaking patients, aged > 18 years, presenting within 48 hours of onset of symptoms who are given a clinical diagnosis of ischaemic stroke or intracerebral haemorrhage that is subsequently confirmed by computerised tomography (CT) imaging
Exclusion criteria
Patients who present to the acute stroke unit 48 hours or greater following onset of symptoms, have non-cerebrovascular causes of acute focal neurological deficits (seizure, hypoglycaemia, toxic or metabolic encephalopathies), sub-arachnoid haemorrhage, or acute and chronic subdural haemorrhage, patients who require palliative care
Outcome results
None listed