Assessment of nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke

Angelina Škodrić; Gorica Marić; Dejana Jovanović; Ljiljana Beslać-Bumbaširević; Darija Kisić-Tepavčević; Tatjana Pekmezović

doi:10.2298/VSP170422156S

Angelina Škodrić Clinical Center of Serbia, Clinic of Neurology, Department for Emergency Neurology, Belgrade, Serbia
Gorica Marić Institute of Epidemiology, Belgrade, Serbia
Dejana Jovanović Clinical Center of Serbia, Clinic of Neurology, Department for Emergency Neurology, Belgrade, Serbia
Ljiljana Beslać-Bumbaširević Clinical Center of Serbia, Clinic of Neurology, Department for Emergency Neurology, Belgrade, Serbia
Darija Kisić-Tepavčević Institute of Epidemiology, Belgrade, Serbia
Tatjana Pekmezović Institute of Epidemiology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP170422156S

Keywords: stroke;, mortality;, nursing care;, nursing;, convalescence.

Abstract

Background/Aim. Stroke remains one of the leading causes of death and disability worldwide. The aim of the study was to determine the nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke (AIS) who were hospitalized at the Department of Emergency Neurology. Methods. Prospective cohort study included 59 consecutive patients with AIS admitted to the Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade. The patients were followed until discharge or death. For exploring a relationship between the outcome of patients with AIS and different groups of factors, the univariate and multivariate Cox proportionate hazard regression models were used. Results. There were 32 male and 27 female patients with AIS. The mean age was 62.5 ± 15.2 years. The average duration of hospitalization was 11.1 ± 9.6 days (median 8 days; range 1–54 days). Almost 80% of patients (47/59; 79.7%) were admitted to the stroke unit, while 12 (20.3%) patients were admitted to the intensive care unit. In the univariate Cox regression analysis the significant variables (p < 0.05) were the Morse score (p = 0.030) and the type of admission unit (p = 0.029). The multivariate predictive model revealed that the type of admission unit (stroke unit vs conventional unit) [hazard ratio (HR) = 0.16; p = 0.032] was the independent predictor of in-hospital mortality in the patients with AIS. Conclusion. The results of this study showed an important role of nursing staff in the recovery of the AIS patients, as well as that admission to the stroke units versus the conventional units is the independent predictor of decreased in-hospital mortality.

References

World Heart Federation. Stroke. Available from: http://www.world-heart-federation.org/cardiovascular-health/ stroke/ [accessed 2016November].

Dolicanin Z, Bogdanovic D, Lazarevic K. Changes in stroke mor-tality trends and premature mortality due to stroke in Serbia, 1992–2013. Int J Public Health 2016; 61(1): 131–7.

GBD Profile: Serbia. Global Burden of Diseases, Injuries, and Risk Factors Study 2010. Seattle, WA: Institute for Health Metrics and Evaluation; 2010. Available from:

http://www.healthmetricsandevaluation.org

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385(9963): 117–71.

Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. Processes of care and medical complications in patients with stroke. Stroke 2011; 42(1): 167–72.

Tung YC, Jeng JS, Chang GM, Chung KP. Processes and out-comes of ischemic stroke care: the influence of hospital level of care. Int J Qual Health Care 2015; 27(4): 260–6.

Ingeman A, Pedersen L, Hundborg HH, Petersen P, Zielke S, Mainz J, et al. Quality of care and mortality among patients with stroke: a nationwide follow-up study. Med Care 2008; 46(1): 63–9.

CMS. Hospital compare: timely and effective care. 2014. Available from: http://www.medicare.gov/hospitalcompare/about/timely-effective-care.html. [accessed 2016 October].

Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; 46: 660–2.

Sulter G, Steen C, De Keyser J. Use of the Barthel Index and modified Rankin skale in acute stroke trials. Stroke 1999; 30(8): 1538–41.

Weir CJ, Bradford AP, Lees KR. The prognostic value of the components of the Glasgow coma scale following acute stroke. QJM 2003; 96(1): 67–74.

Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res 1987; 36(4): 205–10.

Morse JJ, Morse RM, Tylko SJ. Development of a scale to iden-tify the fall-prone patient. Can J Aging 1989; 8(4): 366–77.

Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2007; (4): CD000197.

Seenan P, Long M, Langhorne P. Stroke units in their natural habitat: systematic review of observational studies. Stroke 2007; 38(6): 1886–92.

Zhai S, Gardiner F, Neeman T, Jones B, Gawarikar Y. The Cost-Effectiveness of a Stroke Unit in Providing Enhanced Patient Outcomes in an Australian Teaching Hospital. J Stroke Cere-brovasc Dis 2017; 26(10): 2362–8.

Bokhari FA, Wellwood I, Rudd AG, Langhorne P, Dennis MS, Wolfe CD. Selective admission into stroke unit and patient outcomes: a tale of four cities. Health Econ Rev 2014; 4(1): 1.

Jovanović DR, Beslać-Bumbasirević Lj, Budimkić M, Pekmezović T, Zivković M, Kostić VS. SETIS Investigation Group. Do women benefit more from systemic thrombolysis in acute ischemic stroke? A Serbian experience with thrombolysis in ischemic stroke (SETIS) study. Clin Neurol Neurosurg 2009; 111(9): 729–32.

Stefanovic Budimkic M, Pekmezovic T, Beslac-Bumbasirevic L, Erce-govac M, Berisavac I, Stanarcevic P, et al. Return to Paid Work af-ter Ischemic Stroke in Patients Treated with Intravenous Thrombolysis. Neuroepidemiology 2016; 46(2): 114–7.

Budimkic MS, Pekmezovic T, Beslac-Bumbasirevic L, Ercegovac M, Berisavac I, Stanarcevic P, et al. Long-term medication persis-tence in stroke patients treated with intravenous thrombolysis. Clin Neurol Neurosurg 2016; 141: 19–22.

Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilk-er JA, et al. American Heart Association Council on Cardio-vascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary care of the acute is-chemic stroke patient: a scientific statement from the Ameri-can Heart Association. Stroke 2009; 40(8): 2911–44.

Medic S, Beslac-Bumbasirevic L, Kisic-Tepavcevic D, Pekmezovic T. Short-term and long-term stroke survival: the Belgrade prog-nostic study. J Clin Neurol 2013; 9(1): 14–20.

Wang P, Wang Y, Zhao X, Du W, Wang A, Liu G,et al. In-hospital medical complications associated with stroke recur-rence after initial ischemic stroke: A prospective cohort study from the China National Stroke Registry. Medicine (Balti-more) 2016; 95(37): e4929.

Jeon SB, Ryoo SM, Lee DH, Kwon SU, Jang S, Lee EJ, et al. Mul-tidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis. J Stroke 2017; 19(2): 196–204.

Javier Catangui E, John Roberts C. The lived experiences of nurses in one hyper-acute stroke unit. Br J Nurs 2014; 23(3): 143–8.

Rattray NA, Damush TM, Luckhurst C, Bauer-Martinez CJ, Homoya BJ, Miech EJ. Prime movers: Advanced practice pro-fessionals in the role of stroke coordinator. J Am Assoc Nurse Pract 2017; 29(7): 392–402.

Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Pe-ripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute is-chemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Associa-tion. Stroke 2013; 44(3): 870–947.

Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Car-diology, and Council on Quality of Care and Outcomes Re-search. Guidelines for Adult Stroke Rehabilitation and Re-covery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47(6): e98–e169.

Herdman TH, Kamitsuru S. NANDA International Nursing Di-agnoses: Definitions and Classification, 2015–2017. Oxford: Wiley Blackwell; 2014.