Nursing triage in acute stroke

Abstract

In recent decades, the role of nursing in triage and screening of patients in emergency services, both in prehospital environment and especially in hospitals, is essential and indisputable. In order to analyze the triage carried out by nursing to detect patients with acute stroke, and if necessary improve it, a retrospective study was carried out of the cardinal presentations of stroke, the scale of the National Institute of Health of the United States, and the modified Rankin scale, applied in the nursing triage set at the Salamanca University Hospital, during the period between 2016 and 2019, both inclusive. The total number of clinical records analyzed was 1572. The analysis is focused on the reliability, evaluated by nursing, of the cardinal presentations of acute stroke, and of the two scales, compared to the traditional rapid algorithms for stroke detection, in particular the FAST method, and the Cincinnati scale. Our study shows that there are several clinical presentations that escape the rapid scales, so it is essential to expand the triage methods of acute stroke carried out by nursing, in order to avoid delays in detection and definitive treatment (time-dependent disease). Thus, the expanded identification of cardinal presentations, together with the use of more detailed scales applied by trained nurses, appear to be very useful tools for the detection of acute stroke.