Original Article
Head Position in the Early Phase of Acute Ischemic Stroke: An International Survey of Current Practice

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.023Get rights and content

Background

Evidence to recommend a specific head position for patients in the early phase of acute ischemic stroke (AIS) is scarce. The aim of this study was to assess current head position practice for AIS patients among physicians from hospitals in different countries.

Methods

A cross-sectional survey research design was used; physicians who are part of a stroke research network were invited to participate by e-mail. Descriptive statistics were used.

Results

An invitation to participate was delivered to 298 doctors from 16 countries and 42.9% completed all survey questions. Participant responses were evenly divided in sitting up and lying flat position as the most usual at their hospital: 52.8% (95% confidence interval [CI], 43.7-61.0) of respondents preferred sitting up, whereas 47.2% (95% CI, 38.2-55.5) preferred lying flat; 53.9% (95% CI, 45.3-62.5) of participants answered that no written protocol specifying the indicated head position for stroke patients was available at their hospital or department, and 71% (95% CI, 63.2-78.9) recognized being uncertain about the best position for AIS patients.

Conclusions

Common practice differs between physicians, and there is a lack of consensus about the best strategy regarding head position for AIS patients in many countries. An opportunity exists for a randomized trial to resolve this uncertainty and develop evidence-based consensus protocols to improve patient management and outcomes.

Section snippets

Survey Design and Study Population

A cross-sectional survey of stroke physicians was conducted using a self-administered questionnaire. The survey was constructed and reported in accordance with the published recommendations of the Journal of Medical Internet Research.10 This study was performed following the Australian National Statement on Ethical Conduct in Human Research,11 and ethical approval was obtained from the Human Research Ethics Committee from the University of Sydney.

The sample consisted of all physicians who are

Results

An invitation to participate was initially sent to 316 doctors from 16 different countries, but 18 alerts that the e-mail could not be delivered were received. From the 298 participants who should have received the invitation, 128 (42.9%) completed all survey questions. Only completed questionnaires were analyzed. Figure 1 shows the participant flow diagram. No view rate of the online format was available.

Most of the participants (91.4%; 95% confidence interval [CI], 86.5-96.3) were

Discussion

Our findings suggest that common practice differs between physicians surveyed, and there is a lack of consensus about the best strategy regarding head position for AIS patients. Moreover, most physicians caring for stroke patients are uncertain of the best head position in the acute management of these patients and one third had no positioning preference for any specific patient subsets. This is in agreement with the common absence of written protocols specifying the preferred head position for

Conclusion

There is a lack of consensus regarding practice patterns on the best position in patients with AIS. An opportunity exists for randomized trials to resolve this uncertainty and develop evidence-based consensus protocols to help clinical decision making in this field and improve patient outcomes.

Acknowledgments

We would like to acknowledge all the participants and the investigators who helped in the design and testing of the survey.

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    The authors declare that they did not receive any funding.

    The authors declare that they have no conflict of interests.

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