EBP Compendium: Summary of Clinical Practice Guideline
Institute for Clinical Systems Improvement
Diagnosis and Initial Treatment of Ischemic Stroke
Anderson, D., Larson, D., et al.
Bloomington (MN): Institute for Clinical Systems Improvement, 67 pages.
AGREE Rating: Recommended with Provisos
This guideline provides recommendations for the diagnosis and initial treatment of ischemic stroke. The primary intended audiences for this guideline are health professionals, provider organizations, policy makers, and benefit managers.
- Assessment Instruments
- Bedside Swallow Exam
- “The work group recommends that a bedside swallow test be performed prior to the patient’s ingestion of anything by mouth (including oral aspirin or other medications).” They recommend that the screen be performed in the emergency department by a physician or nurse (p. 40).
- If the screening is negative, bedside swallow evaluation should be performed with 2-3 ounces of water. If no clinical signs of aspiration occur, the patient may receive medications, including aspirin, by mouth (p. 40).
- If the screening is positive or if bedside swallow evaluation reveals clinical signs of aspiration, the patient should not receive anything by mouth, and should be referred for a formal swallow evaluation to be performed by a speech language pathologist. Aspirin will need to be administered via nasogastric tube or per rectum (p. 40).
- “Bedside swallow assessment or more a formal swallow evaluation, and dietary adjustments based on this information, have not been adequately evaluated in sufficiently powered randomized clinical trials. Because these interventions are safe and have a reasonable probability of improving care by decreasing complications, it is reasonable to advocate their use in this setting despite absence of proof of efficacy. Several previously published guidelines advocate these practices” (p. 40).
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Added to Compendium: November 2010