1. DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis
- Author
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Ashfaq Shuaib, Abdul Salam, Zain A. Bhutta, Stephen H. Thomas, Paula Bourke, Deborah Morgan, Mark Santos, Saadat Kamran, Naveed Akhtar, Sujatha Joseph, and Adeel A. Butt
- Subjects
medicine.medical_specialty ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,medicine.disease ,Dysphagia ,Early admission ,03 medical and health sciences ,Prospective analysis ,0302 clinical medicine ,Emergency medicine ,Risk stratification ,Medicine ,medicine.symptom ,business ,Stroke ,030217 neurology & neurosurgery ,Acute stroke - Abstract
BackgroundDelays in transfer of patients from emergency department (ED) to stroke ward increases medical complications. We evaluate if a new risk-score ‘DHOW2’ (dysphagia, hemiplegia, observation-required, wet (incontinence) and weight) will identify high-risk patients and whether expedited admission of ‘high-DHOW2’ score patients to SW will result in fewer complications.MethodsThe DHOW2 score was designed to determine risk of complications following acute stroke. Phase I (279 patients) tested rates of complications with increasing DHOW2. Phase II (1091 patients), evaluated if early admission to the SW of high-DHOW2 patients will lead to fewer complications. Phase III (1257 patients) monitored implementation of the DHOW2 following completion of the study.FindingsMedical complications increased with higher-DHOW2 scores during all three phases; 0%–0.8% with DHOW2 of ≤3, 3.1%–6.5% with DHOW2 of 4–5 and 10.9%–14.1% with DHOW2 of ≥6 (p=InterpretationsThe DHOW2 score detects patients at risk of AS related medical complications. It is easy to implement in busy EDs where nurses can use the score to identify such patients. The risk stratification by DHOW2 and early transfer of high-scoring patients to SW is associated with significantly fewer complications.
- Published
- 2019
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