Reduced post-stroke surveillance in low-risk patients that was safe in low-risk patients

Reduced post-stroke surveillance in low-risk patients that was safe in low-risk patients

The frequency of vital signs and neurological function are assessed in low-risk patients after treatment of acute ischemic stroke does not affect care or recovery, according to new results presented at the 11th European Conference of the European Stroke Organization in Helsinki, Finland.

Results of optimal post-RTPA-IV monitoring in the ischemic stroke study (Optimistmain), published concurrentlyThe lancetalso showed that this approach also had flow for nursing workflow and intensive care resources. The trial was led by Professor Craig Anderson from the George Institute for Global Health and UNSW Sydney and Professor Victor C. Urrutia from the Johns Hopkins University School of Medicine.

Professor Anderson said the guideline's recommended monitoring in the 24 hours after thrombolysis treatment (clot-busting), which was originally developed in the 1990s, takes up significant nursing time and intensive care unit (ICU) beds.

"This attention by nurses from other aspects of care such as education, counseling and support of anxious family members interferes with this monitoring of patients' sleep and may not even be necessary for those who are considered 'low risk,'" he added.

To determine whether monitoring frequency could be safely reduced, researchers studied a total of 4,515 patients with acute ischemic stroke in 8 countries. Patients were monitored according to either a low-intensity protocol (19 assessments over 24 hours after thrombolysis) or standard care (39 assessments).

In both groups, vital signs and neurological assessments were performed every 15 minutes for the first two hours. For the next eight hours, patients were monitored every two hours in the low-intensity monitoring group versus every 30 minutes in the standard group. Up to 24 hours, the low-intensity group was monitored every four hours, compared to hourly monitoring in the standard group.

A comparable proportion of patients experienced a poor functional outcome (death or disability) at 90 days, 31.7% (809 of 2552 participants) in the low-intensity group and 30.9% (606 of 1963) in the standard monitoring group.

The incidence of intracerebral hemorrhage (brain hemorrhage) - the most serious complication of thrombolytic therapy - was low in both groups, in 0.2% of patients in the low-intensity group and 0.4% of patients in the standard monitoring group. Serious adverse events were similar between the low-intensity and standard monitoring groups at 11.1% and 11.3%, respectively.

Professor Anderson said this is the first study of this scale to show that low-intensity nursing is safe and effective in stroke care.

"Regular monitoring in the first few hours of stroke is critical, but we felt that hourly assessments in the following 24 hours may be unnecessary. Our results show that low-intensity monitoring is safe and does not affect patient recovery, outcomes or satisfaction with care.

“We expect this approach will be adopted by hospitals worldwide, particularly when resources are constrained, as it can streamline care and allow nurses to spend more time on other important aspects of the complex care of these patients.”

The protocol not only improved nursing time, but also improved the availability of intensive care beds, particularly in the US, where the proportion of patients admitted to the intensive care unit was 30% lower at hospitals under low-intensity surveillance.

Professor Urrutia, senior author of the study and medical director of the Comprehensive Stroke Center at Johns Hopkins Hospital, said this new approach could support more resilient stroke care.

"This study was conducted in part during the Covid-19 pandemic, when healthcare resources were under extreme strain. While we have overcome many of the pressures of this period, shortages of healthcare workers and hospital beds persist. We expect

Stroke is the second leading cause of death and the third leading cause of disability of all non-communicable diseases worldwide. An acute ischemic stroke is caused by reduced blood flow because a clot blocks one of the major blood vessels in the brain. It includes 65% of all stroke cases and at least a third of ischemic stroke patients have mild to moderate neurological impairment.

Optimistmain was conducted at hospital sites in eight countries, including four high-income countries (Australia, Chile, the United Kingdom, and the United States) and four low- and middle-income countries (China, Malaysia, Mexico, and Vietnam).

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