Effects of stroke nurse-led acute stroke management on treatment time benchmarks, intravenous thrombolysis rates, and patient outcomes: A systematic review and meta-analysis

Abstract

Introduction: Multidisciplinary stroke teams, including a stroke nurse, prove effective in delivering optimal acute ischemic stroke (AIS) management. This systematic review and meta-analysis critically synthesize existing studies to assess the impact of stroke nurse involvement on treatment time benchmarks and patient outcomes.

Method: Data from various databases constituted the primary sources of literature, and the risk of bias and article quality were evaluated using relevant tools. Primary endpoints were door-to-needle (DTN) time, mortality, and good functional outcomes (mRS 0 - 2) at three months. Secondary endpoints included varied treatment time metrics, IVT rates, and length of hospital stay (LOS).

Results: We screened 235 studies published up to September 2023 and ultimately included eight in our analysis. The stroke nurse intervention was significantly associated with a decrease in DTN time (Standard Mean Difference [SMD] = -19.71 min; 95 % CI = [-31.45, -7.97]), reduced three-month mortality rates (Odds Ratio [OR] = 0.56; 95 % CI = [0.37, 0.85]) and improved functional outcomes (OR = 1.33; 95 % CI = [1.03, 1.71]). The IVT rate significantly increased (OR = 1.52; 95 % CI = [1.01, 2.28]) with stroke nurse intervention. However, LOS was comparable (SMD = -0.45 days; 95 % CI = [-1.11, 0.21]) between scenarios with and without stroke nurse involvement.

Conclusions: Our study emphasizes the advantages of including stroke nurses in acute stroke teams, leading to reduced treatment times, increased IVT rates, and enhanced patient outcomes. It highlights the importance of inter-professional stroke teams and evidence-based nursing care to ensure equitable access to high-quality stroke care across diverse healthcare settings.

Keywords: Acute ischemic stroke; Door-to-CT time; Door-to-needle time; Intravenous thrombolysis (IVT); Modified Rankin Scale (mRS); Mortality; Stroke Nurse.