Nurse-led interventions reduce door-to-needle time and improve function in adult stroke patients
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Key Takeaway
Consider nurse-led protocols for improving process times and functional outcomes in stroke care, but note the mortality finding was non-significant.
A systematic review and meta-analysis synthesized evidence from 32 studies involving adult stroke patients (≥18 years) to assess the effectiveness of nurse-led interventions in stroke management. The specific comparator was not reported. The interventions were associated with a significant reduction in door-to-needle time (standardized mean difference: -1.87, 95% CI: -2.91 to -0.82). Neurological function, measured by the NIHSS, showed a pooled weighted mean difference of -0.81 (95% CI: -1.36 to -0.25), indicating improvement. Functional recovery, assessed via the modified Rankin Scale and Barthel index, also demonstrated significant improvements. The pooled odds ratio for mortality was 0.76 (95% CI: 0.44-1.32), which was not statistically significant. Safety and tolerability data, including adverse events and discontinuations, were not reported in the meta-analysis. Key limitations include the lack of a defined comparator group, the absence of reported absolute numbers for outcomes, and the observational nature of the included studies, which precludes causal inference. The findings, while supportive of integrating specialized nursing protocols into stroke care pathways, should be interpreted with caution due to these methodological constraints and the non-significant mortality outcome.
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View Original Abstract ↓
BACKGROUND: Stroke remains a leading cause of mortality and long-term disability worldwide, with timely intervention critical for reducing brain injury. Nurse-led interventions may streamline care and improve outcomes in stroke management.
AIM: This study aimed to synthesize current evidence on the effectiveness of nurse-led interventions on the management of patients with stroke.
METHODS: This review was reported according to PRISMA 2020 guidelines. Comprehensive searches across multiple databases identified 32 studies providing stroke nurse-led intervention for adult stroke patients (≥ 18 years). Outcomes evaluated included mortality, door-to-needle (DTN) time, neurological function (NIHSS), functional recovery (modified Rankin Scale and Barthel index), quality of life (EQ-5D) and length of hospital stay.
RESULTS: Although a non-significant pooled odds ratio of 0.76 (95% CI: 0.44-1.32) was reported for mortality, nurse-led interventions significantly reduced DTN times (SMD: -1.87, 95% CI: -2.91 to -0.82) and improved neurological outcomes, with NIHSS scores showing a pooled weighted mean difference of -0.81 (95% CI: -1.36 to -0.25). Continuous measures of functional recovery assessed by mRS and the Barthel index also demonstrated significant improvements.
CONCLUSION: Stroke nurse-led interventions enhance critical process metrics and neurological recovery in acute stroke care, supporting the integration of specialized nursing protocols in stroke management.
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