title: Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia.
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.
  
  
  METHODS
  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.
authors.affiliation: Nursing Research Institute, St. Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia; School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, NSW, Australia.
authors.forename: Peta
authors.initials: P
authors.lastname: Drury
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McInnes
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hardy
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ward
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Catherine
authors.initials: C
authors.lastname: D' Este
authors.forename: Simeon
authors.initials: S
authors.lastname: Dale
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: N Wah
authors.initials: NW
authors.lastname: Cheung
authors.forename: Clare
authors.initials: C
authors.lastname: Quinn
authors.forename: Rhonda
authors.initials: R
authors.lastname: Griffiths
authors.forename: Malcolm
authors.initials: M
authors.lastname: Evans
authors.forename: Dominique
authors.initials: D
authors.lastname: Cadilhac
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D058633:Antipyretics / Q000627:therapeutic use; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010343:Patient Admission; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*
chemical_list: D058633:Antipyretics; D007004:Hypoglycemic Agents; D007328:Insulin; D000082:Acetaminophen
keywords: fever; hyperglycemia; insulin; paracetamol; stroke; swallow screen