ACU (Australian Catholic University)


Issue 3, Summer 2011

Stroke survival

Stroke survival

A study by the Nursing Research Institute has found three simple protocols to be more effective than the current treatment for acute stroke patients. Alisse Grafitti spoke to Professor Sandy Middleton about the landmark research.

Acute stroke patients who receive three clinical protocols to manage fever, sugar and swallowing are 16 per cent more likely to be alive and independent three months later – a collaborative research study led by Professor Middleton, Director of the Nursing Research Institute at ACU and St Vincents & Mater Health Sydney has found.

The landmark research took out top honours at the 2011 Canadian Stroke Congress, receiving the Top Breakthroughs Co-Chairs’ Award for Impact from over 200 abstracts. It also attracted widespread international media coverage after it was published in The Lancet medical journal in October.

Just last month, Professor Middleton was awarded an additional $2.25 million in funding from the National Health and Medical Research Council (NHMRC) to roll out the trial in emergency departments around Australia.

Stroke is caused by a clot or a bleed in the brain and is Australia’s second biggest cause of death and a leading cause of disability. While a patient suffers irreversible brain damage as a result of the stroke, there is potential to salvage surrounding brain tissue and limit the damage by effectively managing fever, sugar and swallowing.

The NHMRC-funded trial was the first nurse led trial in acute stroke of its kind carried out in Australia – involving 19 acute stroke units across New South Wales and more than 1,600 patients.

The trial developed, implemented and evaluated the effectiveness of teambuilding workshops and education to introduce three clinical protocols to manage fever, sugar and swallowing following an acute stroke.

“We found that patients admitted to hospital with an acute stroke, who received these protocols, were 16 per cent more likely to be alive and independent at 90 days,” Professor Middleton said.

“These results are better than any current drug or treatment for stroke including clot-busting therapy, and can be universally applied in acute stroke units.” The study showed that patients who received care in stroke units using these protocols were also more likely to have fewer episodes of fever, lower average temperatures and sugar levels, and better screening for swallowing difficulties.

“These findings demonstrate that consistent nursing care can be just as important as medical breakthroughs,” Professor Middleton said. “This is the first study of its kind internationally, made all the more significant in that this effect was not due to a drug or a device but as a result of teamwork and good nursing care.”

“While good management of fever, high blood sugar levels and swallowing can salvage brain tissue – poor management can result in extension of the stroke and have devastating consequences for the patient.”

The study was collaboration between ACU, the University of Newcastle, the University of Ottawa, the University of Western Sydney, the University of Sydney and the University of Melbourne, as well as a team of clinicians from NSW Health and support from the Agency for Clinical Innovation’s Stroke Services NSW.

The National Stroke Foundation is encouraging the delivery of such programs in Australian stroke units to support the use of the protocols based on the success of Professor Middleton’s trial.

“Recovery after a stroke can be significantly improved when health professionals are supported to implement protocols that ensure consistent and prompt clinical management of these three factors,” said CEO Dr Erin Lalor.

“The delivery of programs resulting in improved care for stroke care is critical in ensuring more Australians survive stroke, and that costs associated with stroke care are minimised.” Professor Middleton said she was delighted that so many stroke units were eager to step up and adopt the new procedures.

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