Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Roma, Italy.
Int J Nurs Stud. 2024 Oct;158:104859. doi: 10.1016/j.ijnurstu.2024.104859. Epub 2024 Jul 10.
Dysphagia and malnutrition are major contributors to mortality in patients with acute stroke. An early assessment of nutritional status upon hospital admission is crucial to enhance clinical outcomes by reducing the associated high-risk complications. However, the fragmented nature of the existing literature makes it difficult to optimize clinical practices.
This study aims to identify the best clinical practices that nurses and other healthcare professionals can employ for the immediate assessment of nutritional risk in patients diagnosed with acute stroke.
Systematic review of clinical practice guidelines and systematic reviews.
Comprehensive bibliographic searches were conducted up to May 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across the databases Cochrane Library, PubMed, Embase, CINAHL, and Scopus, and three recognized guideline repositories.
The quality of clinical practice guidelines was ascertained using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and the quality of systematic reviews was assessed through A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). The evidence quality was appraised based on the classifications by the European Society of Cardiology.
Out of 2534 identified records, 15 were incorporated into this review. Predominantly, the selected clinical practice guidelines and systematic reviews exhibited high methodological quality. Notably, the Gugging Swallowing Screen and the Malnutrition Universal Screening Tool were pinpointed as primary tools for initial screenings. Most studies recommended that these assessments, ideally conducted within the first 24 h of patient admission, should be carried out by specially trained professionals, highlighting the pivotal role of nurses. Deviations in screening outcomes necessitate complementary specialist evaluations.
This systematic review offers a consolidation of current insights, proposing an innovative and integrated approach to assess nutritional needs of high-risk patients. It underscores the importance of nurses in the screening process, emphasizing their pivotal role in the nutritional management of patients with acute stroke, and advocates for further research endeavors to standardize intervention protocols to elevate patient clinical outcomes.
PROSPERO CRD42023425140.
吞咽困难和营养不良是急性脑卒中患者死亡的主要原因。入院时对营养状况进行早期评估对于通过降低相关高风险并发症来改善临床结局至关重要。然而，现有文献的分散性质使得优化临床实践变得困难。
本研究旨在确定护士和其他医疗保健专业人员可用于立即评估急性脑卒中患者营养风险的最佳临床实践。
临床实践指南和系统评价的系统综述。
根据系统评价和荟萃分析（PRISMA）指南，全面检索了 Cochrane 图书馆、PubMed、Embase、CINAHL 和 Scopus 数据库以及三个公认的指南库截至 2024 年 5 月的文献，检索了综合文献。
使用评估研究和评估工具（AGREE II）仪器确定临床实践指南的质量，并通过评估系统评价的测量工具（AMSTAR 2）评估系统评价的质量。根据欧洲心脏病学会的分类评估证据质量。
在 2534 条记录中，有 15 条被纳入本综述。所选的临床实践指南和系统评价主要具有较高的方法学质量。值得注意的是，Gugging 吞咽筛查和营养不良普遍筛查工具被确定为初步筛查的主要工具。大多数研究建议，这些评估最好在患者入院后的 24 小时内进行，应由专门培训的专业人员进行，突出了护士的关键作用。筛查结果的偏差需要进行补充的专家评估。
本系统评价汇总了当前的见解，提出了一种创新和综合的方法来评估高危患者的营养需求。它强调了护士在筛查过程中的重要性，强调了他们在急性脑卒中患者营养管理中的关键作用，并提倡进一步开展研究工作，以标准化干预方案来提高患者的临床结局。
PROSPERO CRD42023425140。
