Empowering Frontline Care: A Nurse-Led Triage Model for the Early Identification of Malnutrition Risk in Acute Stroke Arif Adi Setiawan (a*) , Eko Wahyudiyanto (b) , Cyruz Polero Tuppal (c), Romeo Jr. B. Pulgarinas (d), Abdulkarim O. Agga (e) , Cemy Nur Fitria (f), Ita Indraswati (f)
a). Emergency & Critical Nursing Department, School Of Nursing,Faculty Of Health Sciences,
Universitas Muhammadiyah PKU Surakarta, Indonesia
*arif_adi[at]umpku.ac.id
b). Emergency Departement, Panti Waluyo Hospital, Surakarta, Indonesia
c). Professor, College of Allied Health, Department of Nursing, National University Philippines
d). Critical Care Nurse, First Choice National (Trinity Health), Livonia, Michigan, USA
e). Department Head Education and Training Dept. Qatar Care, Doha, Qatar
f). Medical & Surgical Nursing Department, School Of Nursing,Faculty Of Health Sciences,
Universitas Muhammadiyah PKU Surakarta, Indonesia
Abstract
Background: Malnutrition is a severe complication in acute stroke patients that worsens clinical outcomes. However, Emergency Department (ED) nurses lack a rapid, objective tool to identify patients at high nutritional risk upon admission, creating a significant gap between clinical guidelines and frontline practice.
Purpose: This study aimed to develop a pragmatic, nurse-led triage indicator using two standard assessments-the Glasgow Coma Scale (GCS) and stroke type-to immediately identify high-risk stroke patients upon ED admission.
Methods: A secondary analysis was conducted on data from 60 acute stroke patients. The primary outcome, malnutrition risk, was assessed using the Malnutrition Screening Tool (MST) and categorized as ^High Risk^ versus ^Low/Moderate Risk^. Bivariate analysis, including the calculation of Odds Ratios (OR), was used to evaluate the predictive strength of hemorrhagic stroke and admission GCS score.
Results: Over one-fifth of the patients (21.7%) were at high risk for malnutrition. The presence of a hemorrhagic stroke increased the odds of a patient being at high malnutrition risk by 8.5 times compared to a non-hemorrhagic stroke (OR=8.5, p=0.008). A low GCS score was also profoundly associated with high-risk status, with a median GCS of 9 in the high-risk group compared to 13 in the low/moderate-risk group (p<0.001).
Conclusion : A simple triage rule is proposed: ^Acute stroke patients with a GCS score of 11 or lower, OR a diagnosis of hemorrhagic stroke, should be automatically prioritized for a comprehensive nutritional assessment.^ This tool empowers nurses by integrating nutritional risk identification into their initial assessment using existing data. It helps bridge a critical gap in acute stroke care, facilitating timely interventions and fostering proactive interdisciplinary collaboration from the moment of patient arrival.
