Introduction: Clinical monitoring after reperfusion therapies in acute stroke care helps identify deterioration from intracerebral hemorrhage lending to clinical intervention. Since completion, NINDS Stroke Trial monitoring algorithms aid in early recognition and treatment of clinical deterioration. Mechanical thrombectomy adds complexity and additional patients for nursing to follow needing critical care. Development of alternative algorithms for monitroing post-reperfusion is essential to allocating limited resources. OPTIMISTmain found that patients with less acute disability from their acute stroke could receive less intense monitoring without apparent harm. Whether all post-reperfusion patients would benefit from an alternative clinical pathway with monitoring adjusted to both disabilty and type(s) of reperfusion strategy is unknown. Hypothesis: Post-reperfusion surveillance inclusive of thrombolysis and mechanical thrombectomy can be modified from traditional standards without clinical harm. Methods: Traditional monitoring assesses NIH stroke score at 15 minute intervals for 2 hours, then every 30 minutes for 6 hours, then every hour for 16 hours. Moderate intensity care altered care at 2 hours to every hour and after 10 hours to low-intensity every 4 hours until 24 hours. Patients after mechanical thrombectomy were traditionally monitored. When only intravenous thrombolysis had been given, clinicians decided whether traditional or moderate intensity post-reperfusion surveillance was indicated. After 10 hours a decision to employ low-intensity occurred. Results: During 2023, 458 patients were monitored: 189 traditional, 268 moderate with 27 transitioning to low-inensity. Eighteen patients in both groups clinically worsened resulting in imaging. Intracranial hemorrhage occurred in 10 patients (5.3%) surveillanced traditionally and 8 patients (3%) followed moderately, ovrall 3.9%. No patient transitioning to low-intensity bled. The control cohort bled 3.7% within 24-hours of reperfusion. Nursing performed and documented 1824 fewer NIHSS examinations. Conclusions: Moderate intensity monitoring surveillances post-reperfusion without evidence of harm. Alternative allocation of nursing and critical care resources led to similar care. Processes need to continue to develop to improve care and use limited resources.
Hanna et al. (Thu,) studied this question.