Abstract TP342: Effectiveness of Nursing Neuro-checks in Patients With Acute Stroke

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Introduction: In the certification of primary and comprehensive stroke centers The Joint Commission cites neuro assessments/reassessment (neuro-checks) as one of the most problematic standards. The role of neuro-checks (NC) is to readily detect neurological change, but it is surprising that the assessment has undergone relatively little scientific study. Their effectiveness in detecting worsening in acute ischemic stroke patients has not been well examined. The aim of this study is to establish the usefulness of neuro-checks to detect neurological deterioration. Methods: We performed a retrospective chart review of acute ischemic strokes treated with IV tPA in 2017 at a large Comprehensive Stroke Center. Demographics, baseline and 24-hour NIHSS score, vascular risk factors, vascular syndrome at presentation and neuro-check findings during the first 72 hours following admission were recorded. NC consist of an assessment of orientation, Glasgow Coma Scale (GCS), arm and leg strength and sensation. Neurological deterioration was defined as worsening in the clinical judgement of a vascular neurologist during daily patient visits. Frequency and reasons of neurological deterioration and detection rates by neuro-checks were collected. Results: 107 patients were analyzed (52% male, age 69.7 ± 15.6 [mean+/-SD] years). Mean NIHSS score was 12 ± 7.3 on arrival and 7.8 ± 7.6 at 24 hours. An average of 63.3 ± 13.9 neuro-checks were performed per patient. Neurological deterioration was observed in 28 (26%) patients. Of these, 12 (42%) were detected by NC, 9 (32%) by nurses outside of the scheduled NC time and 7 (25%) remained undetected and were found during follow up physician visits. The most common components of the NC that helped detection were decreased motor strength and confusion. Most common reasons for failure to discover deterioration were gradual decline (3/7 [42%]) and transfer to floor (2/7 [28.5%]). Conclusions: While NC increase the chance of detecting neurological deterioration in patients with acute stroke a significant proportion of deteriorations are found outside scheduled assessments or remained undetected. This suggests that novel monitoring strategies are needed to readily identify worsening neurological status in acute stroke.

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