User:Ci Mar-Gar/QASC

The Quality in Acute Stroke Care Trial (QASC) was a research trial demonstrating that acute stroke patients who received improved management of fever, sugar and swallow, were 16% more likely to be alive or independent three months after their stroke.

Background
The trial was a cluster randomized controlled trial (CRCT) in NSW Australia FROM **, examining the effect on death, disability and dependency of a multidisciplinary intervention to improve management of fever, hyperglycaemia and swallowing dysfunction following acute stroke.

A total of 1699 patients from 19 Australian Acute Stroke Units were recruited for this study and included both pre intervention (n= 690 patients) and post intervention (n=1009). Acute Stroke Units were randomised to intervention (n=10) or control (n=9)sites. The intervention Acute Stroke Units received evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing dysfunction, in conjunction with multidisciplinary team building workshops, a standardised staff education program and engagement of local stroke unit coordinators. Control Acute Stroke Units received only an abridged copy of the Australian acute stroke guidelines relevant to fever, hyperglycaemia and swallowing management. Patient outcome data were obtained via a computerized assisted telephone interview 90-days post-admission. The results of the QASC trial showed that patients from control-group Acute Stroke Units were significantly more likely to be dead or disabled at 90-days with a modified Rankin Scale (MRS)> 2, compared to patients from intervention ASUs (58% vs 42%; P=0.006) and to have lower SF-36 physical health scores (mean 42.5 vs 45.6; P=0.002).ADD ON FESS AND MAKE SURE IT DOESNT SOUND LIKE LANCET***

This study is a landmark in stroke research demonstrating a 16% absolute improvement in death or disability at 90-days for patients who received care in Acute Stroke Units delivering the multidisciplinary intervention. It provides compelling evidence that multidisciplinary care to manage fever, hyperglycaemia and swallowing dysfunction can decrease death, disability and improve health status.

After the Trial
The QASC Trial was one of the first nurse-led cluster trials in acute stroke in Australia lead by a team from the Nursing Research Institute and was published as a fast-track publication in The Lancet in 2011. As part of the study, The QASC protocols were published and all QASC resources including the Fever, Sugar, Swallow protocols and implementation strategies used during the trial are freely available for clinicians and the general public to download ** CHECK THAT THIS IS THE DOWNLOAD WEBSITE