Nutrition and hydration practices in acute stroke care: An international cross-sectional survey.

Abstract

Background And Aims: Dehydration and malnutrition are common in hospitalised stroke patients and are associated with poor outcomes including mortality. This study aimed to capture how nutrition and hydration is currently assessed and managed in the UK and Australia (AUS). Method(s): Cross-sectional survey of 337 hospitals (April to November 2019) providing inpatient care for stroke patients (UK N=174; AUS N=163). Responses were analysed using descriptive statistics. Result(s): 270 respondents (UK N=150 86%; AUS N=120 74%) from a range of clinical settings (121 acute stroke unit; 19 stroke ward; 63 integrated acute and rehabilitation; 56 rehabilitation; 11 other). Nutritional status was most likely to be assessed on admission (UK 79%; AUS 84%) by a Nurse (UK 97%; AUS 83%) or Dietician (UK 70%; AUS 85%). In the UK, 90% utilised the Malnutrition Universal Tool (MUST), compared with 50% in AUS. Management decisions regarding calorie-intake were the realm of Dieticians (UK 98%; AUS 97%). Hydration assessment was undertaken by Nurses (UK 87%; AUS 79%) or Doctors (UK 81%; AUS 88%) on admission (UK 62%; AUS 58%) and repeated daily (UK 65%; AUS 61%) using a combination of visual assessment (UK 65%; AUS 61%) and clinical tests (Urine Specific Gravity UK 22%; AUS 46%; Urea:creatinine UK 3%; AUS 20%). Hydration management decisions were primarily made by physicians (UK 84%; AUS 83%). Conclusion(s): Nutrition and hydration practices are broadly similar in the UK and AUS, with Nurses taking responsibility for assessment and monitoring, while Dieticians and Physicians undertake decisionmaking regarding management. The survey findings will inform further research and education.