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User:Ci Mar-Gar/QASC

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The Quality in Acute Stroke Care Trial (QASC) was a research trial demonstrating that acute stroke patients who received improved management of fever, sugar and swallowing reflects, were 16% more likely to be alive or independent three months after their stroke. The study has generated significant interest amongst stroke research community following its publication in 2011 [1] due to the significant results of the trial showing the lowest? number needed to treat (NNT=6.4)known to date of stroke treatments.

Background

The Trial was a cluster randomized controlled trial (CRCT), examining the effect on death, disability and dependency of a multidisciplinary intervention to improve management of fever, hyperglycaemia and swallowing dysfunction following acute stroke in NSW, Australia.

A total of 1699 patients from 19 Australian Acute Stroke Units (ASUs) were recruited for this study; both pre intervention (n= 690 patients)and post intervention (n=1009). ASU’s were randomised to intervention (n=10) or control (n=9)sites. The intervention ASUs received evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing dysfunction, in conjunction with multidisciplinary team building workshops, a standardised staff education program and engagement of local stroke unit coordinators. Control ASUs received only an abridged copy of the Australian acute stroke guidelines relevant to fever, hyperglycaemia and swallowing management. Patient outcome data were obtained via a computerized assisted telephone interview 90-days post-admission. Intention to treat analysis was used adjusting for baseline data and clustering. The results of the QASC trial showed that patients from control-group ASUs were significantly more likely to be dead or disabled at 90-days with a modified Rankin Scale (MRS)> 2, compared to patients from intervention ASUs (58% vs 42%; P=0.006) and to have lower SF-36 physical health scores (mean 42.5 vs 45.6; P=0.002).

This study is a landmark demonstrating a 16% absolute improvement in death or disability at 90-days for patients who received care in ASUs delivering the multidisciplinary intervention. It provides compelling evidence that multidisciplinary care to manage fever, hyperglycaemia and swallowing dysfunction can decrease death, disability and improve health status.

After the Trial

The QASC Trial was one of the first nurse-led trials in acute stroke in Australia led by Professor Sandy Middleton from the Nursing Research Institute in Australia [2][3]and was published as a fast-track publication in The Lancet in 2011 [1]. As part of the study, The QASC protocols were published [4] and all QASC resources including the Fever, Sugar, Swallow protocols and implementation strategies used during the trialhave been freely available for clinicians and the general public to download [5]

References

  1. ^ a b Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este C, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. The Lancet. 2011;378 (9804):1699-706.
  2. ^ http://www.nursingresearch.com.au
  3. ^ http://corner.acu.edu.au/research_supervision/framework/browse.php?srperid=53
  4. ^ Middleton S, Levi C, Ward J, Grimshaw J, Griffiths R, D'Este C, et al. Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: A cluster randomised controlled trial of knowledge transfer. Implementation Science. 2009;4:16
  5. ^ http://www.acu.edu.au/about_acu/faculties,_institutes_and_centres/health_sciences/research/quality_in_acute_stroke_care
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