Background: Acute stroke treatments like IV thrombolysis and mechanical thrombectomy improve patient outcomes, but the standard practice of frequent monitoring for 24 hours post-intervention is resource intensive. It is unclear if some patients can safely receive less intensive monitoring without increased risk. This project evaluates the effectiveness and safety of a risk-based, intensity-adjusted post-stroke intensive care unit (ICU) monitoring protocol. Methods: Before August 2020, all post-acute stroke intervention patients received hourly monitoring in the neuro ICU for 24 hours. Starting August 2020, patients were stratified by risk into high-intensity (frequent checks through 24 hours) or low-intensity (less frequent checks after 10 hours) monitoring based on specific clinical criteria including presence of ongoing ICU needs, size of stroke core, number of thrombectomy passes, extent of recanalization, NIHSS on presentation, age, presence of a concurrent cardiac event, history of diabetes or suspicion of cardioembolic source. Demographic, clinical, and outcome data were collected retrospectively for those monitored conventionally (Jan 2018–Jul 2020) and for those in the new intensity-based protocol (Aug 2020–Dec 2023). Results: A total of 416 charts were reviewed under conventional monitoring and 543 under intensity-based monitoring. Demographics were similar between groups. Favorable (0-2) 90-day modified Rankin scale (mRS) were similar in the conventional vs intensity-based group (42.5% vs 42%; p=1.00). Symptomatic intracerebral hemorrhage (ICH) within 36 hours was 2.6% vs. 1.5%, respectively. ICU stay was shorter in the low intensity group (1.3 days) compared to the high intensity group (2.9 days). Conclusions: Using a pre-determined set of criteria to risk-stratify patients for intensity-based post-stroke intervention monitoring did not result in an increase in symptomatic ICH within 36 hours or worsening of 90-day mRS. An intensity-based monitoring protocol may be an effective way to reduce ICU resource utilization without adversely affecting short-term adverse events or long-term functional outcomes for acute stroke patients undergoing treatment with IV thrombolysis and/or mechanical thrombectomy.
Crooks et al. (Thu,) studied this question.