Table 4 Medical management of stroke patient during hospital stay
From: Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit
Before the introduction of pathway | After the introduction of pathway | p-value | ||
|---|---|---|---|---|
Investigations during the admission | CT scan in 1st 48 hrs | 96% | 92% | 0.293 |
Carotid duplex ultrasound | 26% | 28% | 0.817 | |
Echocardiogram | 42% | 26% | 0.047 | |
ESR or CRP in 1st 48 hrs | 57% | 61% | 0.143 | |
Fasting blood sugar and lipids | 32% | 44% | 0.143 | |
MRI | 10% | 5% | 0.238 | |
Specific medical issues | Aspirin given in first 48 hours to patients without contraindications | 26/55 (46%) | 40/66 (61%) | 0.117 |
Paracetamol given to those with fever > 38°C in first 48 hours | 3/4 (75%) | 5/5 (100%) | 0.574 | |
Acute blood pressure management consistent with guideline | 63.6% | 71.1% | 0.328 | |
Prophylaxis for deep vein thrombosis (except aspirin) | 20.8% | 14.5% | 0.306 | |
Hypoglycemic agents given to those with blood sugar >15 mmol/l in first 48 hours | 1/2 (50%) | 2/2 (100%) | 0.312 | |
Risk factor treatment at discharge | Anti-hypertensive treatment if sBP>140 or dBP>90 at any time during admission | 44/50 (88%) | 51/58 (88%) | 0.242 |
Warfarin if ECG shows atrial fibrillation | 6/18 (33%) | 4/10 (40%) | 0.264 | |
Statin if total cholesterol > 3.5 | 42/55 (76%) | 48/61 (79%) | 0.341 | |
Cessation programme for current smokers | 5/10 (50%) | 8/10 (80%) | 0.638 | |
Optimisation of glycemic control if diabetes present | 8/12 (67%) | 8/9 (100%) | 0.410 | |
US carotid arteries requested or performed if anterior circulation infarct | 19/60 (32%) | 24/59 (41%) | 0.610 |