Background: Stroke is one of the most feared postoperative complications. However, the diagnosis is usually delayed leading to a reduced therapeutic window.
Objective: To develop a protocol aimed to shorten the time of detecting a neurological deficit in postoperative patients.
Methods: We used a pre-post intervention design to evaluate time of stroke recognition in post-opened heart surgery patients. The intervention consisted of: 1) A new postoperative protocol to evaluate any new neurological deficit < 14 days after surgery. Nurses were trained to perform a simple sequential neurological assessment including observing eye deviation and testing for asymmetrical limb movement. The protocol was applied during the vital sign measurement schedule. Stroke code was activated if the deficit was confirmed by MD. 2) Educational program for nurses concerning postoperative stroke complications and the importance of time.
Results: During Jan, 2014 - Oct, 2015, we consecutively reviewed 27 patients with acute neurological deficit < 14 days after surgery. Twenty-five consecutive patients with postoperative neurological deficit were enrolled during post-intervention period (Nov, 2015 - Jul, 2016). Male consisted of 19/27 (70.4%) and 179/297 (60.3%) (P=0.303), the mean ± SD age of 64.56 ± 13.13 and 62.43 ± 13.45 years (P=0.432) and the mean initial NIHSS of 16.25 ± 8.45 and 12.92 ± 10.78 (P=0.402) in pre and post intervention respectively. When comparing between pre and post intervention, we found that stroke fast track activation was significantly increased from 4/27(14.8%) to 13/25(52%) (P=0.004), the median (min-max) duration from time last seen normal to first neurological deficit detection reduced from 690 (20-9190) to 120 (5-5935) minutes (P=0.004), the median duration from onset to CT decreased from 150 (33-11009) to 65 (31-3779) minutes (P=0.163). Number needed to treat for early detection when the protocol being used was 2.4. There was an increasing trend in endovascular treatment from 0 to 2/25 (8%) after the intervention.
Conclusions: A simple protocol for a postoperative neurological assessment after cardiac surgery showed a significant reduction in the time to diagnosis thus, increasing the patients’ therapeutic opportunity.