Management of fever, blood sugar and swallowing problems boosts survival, functioning, study finds

By Randy Dotinga
HealthDay Reporter

WEDNESDAY, Oct. 12 (HealthDay News) -- Stroke patients function better physically and are less likely to die if they undergo treatment that pays special attention to fever, high blood sugar and swallowing problems, new research suggests.

"Clinical leaders of stroke services can adopt this strategy with confidence that their outcomes will improve," Sandy Middleton, a professor at the Nursing Research Institute at St. Vincent's & Mater Health in Sydney, Australia, and colleagues wrote in the report in the Oct. 12 online edition of The Lancet.

The researchers noted that patients who recover in units devoted to stroke care often experience fever (20 to 50 percent of patients), high blood sugar (up to half of patients) and problems swallowing (37 to 78 percent of patients) within the first few days of a stroke. These conditions "are not yet universally well managed," the study authors indicated.

In the study, Middleton and colleagues randomly assigned patients at 19 stroke units in New South Wales, Australia, to different types of treatment. Some followed existing guidelines, while others adopted new protocols involving monitoring of fever and high blood sugar plus treatment for the conditions. Nurses also underwent special training to treat swallowing problems in the patients.

Within 90 days, 42 percent of the 558 patients in the group that received the special treatment were dead or considered to be dependent, compared with 58 percent of the 449 patients who received the existing treatment, the investigators reported.

Patients who received the special treatment also scored better on a test of their physical functioning, the results showed.

Commenting on the study, Dr. James S. McKinney, assistant professor of neurology at the University of Medicine and Dentistry of New Jersey, said the results are "astounding."

"Stroke patients should be cared for at designated stroke centers that implement treatment protocols, such as those described by the authors," said McKinney, who had no role in the study. "It has never been more apparent that the type and quality of hospital stroke patients are admitted to impacts their recovery and functional outcome."

More information

For more about stroke, visit the U.S. National Library of Medicine.

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SOURCES:

• The Lancet, news release, Oct. 11, 2011;
• James S. McKinney, M.D., assistant professor of neurology, University of Medicine and Dentistry of New Jersey, New Brunswick