Background: In the Australian QASC Trial (Lancet 2013), better glucose and fever control improved 90 day outcomes when nurses adhered to strict monitoring/treatment protocols. We examined variance from guideline specific care for glucose and fever in an American sample.
Methods: An observational study was conducted to assess compliance with AHA/ASA stroke guidelines for glucose and fever control in consecutive acute stroke patients from 5 different U.S. Stroke Centers. The first 5-days of glucose/temperature data were analyzed along with demographics and outcome measures.
Results: A total of 1669 consecutive glucose and 3782 consecutive temperature measurements were taken from a sample of 235 acute stroke patients; the sample was 87% ischemic and 13% ICH, with admission median NIHSS 4.0 (range 0-34) and ICH score median 1 (range 0-5). 26% of ischemic strokes received IVtPA and/or thrombectomy. HbA1c was 5.7+.65 (median range 4.8-11.2) in non-DM diagnosed patients vs. 8.3+2.3 (range 5.0-14.1; 95%CI=1.9-3.1; p<0.001) in DM patients. Glucose was >180 mg/dL for >4 hours in 33% during hospitalization (Table), and the most frequent method (35%) for glucose control was regular insulin sliding scale. Temperature was >37.5o (noncompliant with European/Australian [E/A] standards) for >4 hours in 27% of patients, and >38o (noncompliant with US standards) for >4 hours in 10% of patients; 8% were out-of-control >8 hours (range 9-96, median 16.5 hours out-of-control) and 39% did not have temperature measured in the ED. mRS and LOS were significantly worse if temperature exceeded the E/A and US standards (Table). Temperature control to <37.5o C was an independent predictor (p<0.001) of favorable (0-2) mRS at discharge.
Conclusions: Our study underscores the need for more vigilant control of glucose and temperature by nurses at U.S. hospitals. Given the time-sensitive ability of brain to recover from ischemia, even short-term non-compliance may have detrimental effects.