Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial

This article reviews the QASC trial which implemented evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke patients. The study found that multidisciplinary intervention led to better patient outcomes and reduced healthcare costs.

Running head: ARTICLE REVIEW
Article Review
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1ARTICLE REVIEW
The research paper authored by Middleton et al. (2011) had the focus on the appropriate
process of addressing hyperglycemia, fever and swallowing dysfunction experienced by patients
who are admitted to acute stroke units when an implementation of evidence-based treatment
protocols is considered. The evidence-based treatment protocols have the foundation on
multidisciplinary intervention. 19 Acute stroke units were assigned in a random manner to
intervention (n=10) or control (n=9). During the research, out of the 6564 individuals assessed to
be included in the study, patient data for 1696 was obtained. The study had the research design
of single-blind cluster randomized controlled trial. While the patients recruited for the study were
blinded to the group allocation, the same was not the case for clinicians responsible for
delivering the intervention. The researcher did not mention whether the groups were given equal
treatment aside from the experimental intervention. The primary outcomes measured 90 days
after hospital admission were death or dependency, functional dependency, Mean SF-36 mental
component summary (MCS) score, and Mean physical component summary (PCS) score. The
results indicated that intervention ASU patients were significantly less likely to be dead or
dependent (mRS ≥2) at 90 days than control ASU patients (236 [42%] of 558 patients in the
intervention group vs 259 [58%] of 449 in the control group, p=0·002; number needed to treat
6·4; adjusted absolute difference 15·7% [95% CI 5·8–25·4]). It was further indicated that they
had better SF-36 mean physical component summary score (45·6 [SD 10·2] in the intervention
group vs 42·5 [10·5] in the control group, p=0·002; adjusted absolute difference 3·4 [95% CI
1·2–5·5]).
The study findings are applicable to acute stroke units only and further research is
warranted to understand the value of the intervention for other patient populations (LoBiondo-
Wood & Haber 2017). The inference drawn from the research is that utilization of

2ARTICLE REVIEW
multidisciplinary supported evidence-based protocol to be administered by nurses for managing
fever, hyperglycaemia, and swallowing dysfunction can be the contributory factor for better
patient outcomes after they are discharged from the unit. The benefits are worth the cost of
intervention since the health outcomes of the patient after their discharge from the respective
stroke unit would be better, thereby reducing chances of readmission. The ultimate impact would
be reduction in healthcare costs and burden on healthcare professionals (Baatiema et al., 2017).

3ARTICLE REVIEW
References
Baatiema, L., Otim, M. E., Mnatzaganian, G., Aikins, A. D. G., Coombes, J., & Somerset, S.
(2017). Health professionals’ views on the barriers and enablers to evidence-based
practice for acute stroke care: a systematic review. Implementation Science, 12(1), 74.
DOI: https://doi.org/10.1186/s13012-017-0599-3
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Retrieved from
https://books.google.co.in/books?
hl=en&lr=&id=vGclDwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research+book&ots=9
IUDNCGTc6&sig=k7QPNApNenvkaGp3NjCNg2qviTE#v=onepage&q=nursing
%20research%20book&f=false
Middleton, S., McElduff, P., Ward, J., Grimshaw, J. M., Dale, S., D'Este, C., ... & Evans, M.
(2011). Implementation of evidence-based treatment protocols to manage fever,
hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster
randomised controlled trial. The Lancet, 378(9804), 1699-1706. DOI:10.1016/S0140-
6736(11)61485-2