Systematic ReviewResearchWorkflowMedication Safety

Selected patients benefited from extended-window stroke thrombolysis, with more symptomatic bleeding

Neurology (PubMed)Jul 23, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

An updated meta-analysis of 13 randomized studies and individual-patient-data meta-analyses found that IV thrombolysis beyond 4.5 hours improved 90-day functional outcomes in selected acute ischemic stroke patients while increasing symptomatic intracranial hemorrhage.

What NurseJet pulled from the source

The pooled evidence included 2,456 patients receiving thrombolysis plus best medical therapy and 2,411 controls. Excellent functional outcome was more likely with thrombolysis, with a reported number needed to treat of 13, while symptomatic intracranial hemorrhage was also more frequent, with a reported number needed to harm of 75. Any intracranial hemorrhage and 90-day mortality did not differ significantly.

Why this matters for nurses

Emergency and neurology nurses help establish last-known-well time, obtain rapid imaging and laboratory data, prepare eligible patients, and detect hemorrhagic or neurologic deterioration after treatment. The review reinforces both the potential benefit of timely extended-window evaluation and the need for close post-thrombolysis surveillance.

Bedside takeaway

Extended-window thrombolysis improved functional outcomes in selected patients but increased symptomatic intracranial hemorrhage.

How This Applies in Practice

Use this when: Evaluating or monitoring a patient with acute ischemic stroke who presents beyond 4.5 hours from last known well.

On your shift

Activate the stroke pathway and document last known well, baseline neurologic findings, medications, and other eligibility data without delaying imaging.
Prepare for treatment only after the designated stroke clinician confirms the patient meets the local extended-window criteria.
If thrombolysis is given, complete the ordered neurologic, blood-pressure, and bleeding checks and escalate any deterioration immediately.

Keep in mind: The pooled evidence does not create a universal treatment window or replace individual selection. Follow the stroke protocol, facility policy, and patient-specific provider orders.

Explain this for my unit

Key takeaways

The analysis evaluated thrombolysis initiated more than 4.5 hours after last known well in imaging-selected or otherwise trial-eligible patients.
Excellent and good functional outcomes at 90 days favored thrombolysis across the pooled evidence.
Symptomatic intracranial hemorrhage increased, although any hemorrhage and all-cause mortality were similar between groups.
The findings apply to selected trial populations and do not replace local eligibility, imaging, contraindication, or treatment protocols.

Practice implications

Activate the stroke pathway without excluding a patient solely because more than 4.5 hours have elapsed. Capture the timing and eligibility data required by the local protocol, then perform the prescribed neurologic, blood-pressure, and bleeding surveillance if thrombolysis is ordered.

Limitations & cautions

The meta-analysis combined randomized trials and individual-patient-data meta-analyses with different agents, time windows, imaging strategies, vascular territories, and use of endovascular treatment. Selection criteria were trial-specific, and pooled findings do not define eligibility or treatment for an individual patient.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

Neurology (PubMed)

Neurology (PubMed). IV Thrombolysis in the Extended Time Window for Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42492020/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Neurology (PubMed)Jul 22, 2026Systematic ReviewPractice applicable

A systematic review of 10 publications on acute MOG antibody-associated disease found that plasmapheresis was associated with favorable visual and neurologic recovery, but high heterogeneity and nonrandomized evidence prevent causal comparisons with other acute treatments.

EmergencyAI summaryReview source

Systematic ReviewResearchWorkflowPractice applicableAI summary · original source linked below

The review included 1,045 patients and 1,368 attacks; eight studies with 710 patients and 1,033 attacks contributed to meta-analysis. In optic neuritis, plasmapheresis was associated with improved visual acuity and an estimated 81% excellent-recovery rate, although the confidence interval was very wide. Good recovery was also common in attacks involving myelitis or cerebral disease, and pooled plasmapheresis-related adverse effects were 3%.

Key takeaways

Ten publications included 1,045 patients with 1,368 acute MOGAD attacks.
Eight studies contributed data for meta-analysis, including 710 patients and 1,033 attacks.
Plasmapheresis was associated with visual improvement in optic neuritis and favorable recovery in other attack presentations.
High heterogeneity, variable timing and severity, and the absence of randomized comparisons limit treatment-effect and safety conclusions.

Why this matters on shift

Neurology nurses help recognize evolving visual, motor, sensory, and cerebral symptoms, establish a pre-treatment baseline, and monitor patients during escalation therapy. The review supports careful response tracking while emphasizing that pooled observational recovery rates do not identify who should receive plasmapheresis or when.

Bedside takeaway

Plasmapheresis was associated with recovery in acute MOGAD, but nonrandomized evidence cannot define comparative benefit or optimal timing.

Nursing implications

Document the neurologic and visual baseline before treatment when feasible, follow the ordered plasmapheresis monitoring pathway, and trend the same clinical domains across exchanges. Escalate deterioration, treatment intolerance, or new symptoms promptly through the neurology and apheresis teams.

Limitations & cautions

The evidence came from heterogeneous, nonrandomized studies with differences in attack type, severity, prior treatment, plasmapheresis timing, and outcome definitions. Recovery estimates had wide intervals, confounding by treatment selection is likely, and a low pooled adverse-effect rate cannot establish comparative safety.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Neurology (PubMed). Effectiveness and Safety of Plasmapheresis in MOGAD Attacks: A Systematic Review and Meta-Analysis.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses (PubMed)Jul 21, 2026Systematic ReviewPractice applicable

A systematic review of 10 experimental and quasi-experimental studies reported beneficial effects from nurse-led psychosocial, physical-activity, and self-management interventions for poststroke fatigue, while methodological concerns across studies limited confidence in the findings.

EmergencyAI summaryReview source

Systematic ReviewResearchPatient EducationPractice applicableAI summary · original source linked below

The PRISMA-guided review included 10 studies of adults with stroke comparing nurse-led fatigue interventions with usual care. Programs were usually delivered individually and included psychosocial support, physical activity, and self-management strategies. The authors reported beneficial effects and emphasized proactive fatigue assessment, but several studies had concerns involving blinding and design. The abstract does not provide pooled effect estimates or establish which intervention component works best.

Key takeaways

Ten experimental or quasi-experimental studies evaluated nurse-led interventions for fatigue after stroke.
Interventions included psychosocial approaches, physical activity, and self-management strategies and were usually delivered individually.
The review reported beneficial effects and highlighted proactive fatigue assessment in rehabilitation nursing.
Methodological concerns, including blinding and study-design limitations, reduce confidence and prevent selection of a single best approach.

Why this matters on shift

Fatigue can limit participation in rehabilitation and daily activities even when neurologic recovery appears stable. Neuro and rehabilitation nurses are well positioned to ask about fatigue, identify contributing symptoms or treatment effects, pace care, and coordinate individualized follow-up with the multidisciplinary team.

Bedside takeaway

Nurse-led fatigue support appears promising after stroke, but assessment and interventions should remain individualized because the evidence base is small.

Nursing implications

Include fatigue in routine stroke recovery assessment, document its timing and effect on function, and screen for clinical contributors through the established care pathway. Coordinate individualized activity pacing, education, and referrals rather than applying a single intervention package to every survivor.

Limitations & cautions

The review included only 10 studies, mixed experimental and quasi-experimental designs, and noted methodological concerns involving blinding and study design. The abstract provides no pooled effect size, comparison of specific intervention components, or detailed durability data, so the relative effectiveness of psychosocial, activity, and self-management approaches remains uncertain.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses (PubMed). Effectiveness of Nursing Interventions for Poststroke Fatigue: A Systematic Review.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Pediatrics (PubMed)Jul 21, 2026Research ArticlePractice applicable

In a prospective two-site study of 472 pediatric emergency behavioral-health encounters, the five-item nurse-completed BRACHA-S showed moderate discrimination for agitation requiring medication or restraint and identified a stepwise rise in risk as scores increased.

Peds PsychAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

Emergency nurses completed the BRACHA-S at triage for children and adolescents age 5 to 18 presenting with mental or behavioral-health concerns. Agitation requiring intervention occurred in 55 of 472 encounters. The score's area under the receiver operating characteristic curve was 0.72. Event rates rose from 3.3% at a score of 0 to 31.8% at 4 and 36.0% at 5; compared with scores 0 to 2, relative risk was 2.2 for a score of 3 and 5.9 for scores 4 to 5. The tool supports early risk stratification but does not replace assessment or determine treatment.

Key takeaways

The prospective validation included 472 encounters at two pediatric emergency departments, and 11.7% involved medication for agitation or physical or mechanical restraint.
The five-item nurse-completed score showed moderate discrimination, with an area under the curve of 0.72.
Agitation requiring intervention increased across score levels, reaching 31.8% at a score of 4 and 36.0% at 5.
Low scores had a high negative predictive value but poor specificity, so the score is better used as one input to safety planning than as a stand-alone rule.

Why this matters on shift

Emergency and mental-health nurses often make the first structured assessment when a child arrives in behavioral crisis. A brief triage score may help teams identify who needs earlier environmental precautions, de-escalation planning, and closer observation while preserving individualized clinical assessment.

Bedside takeaway

A short nurse triage score identified meaningful pediatric agitation-risk gradients, but it should inform rather than replace ongoing assessment and safety planning.

Nursing implications

If the BRACHA-S is part of the local workflow, complete it alongside the full behavioral and safety assessment, communicate elevated scores during handoff, and start protocol-directed de-escalation and environmental planning early. Reassess when behavior or clinical status changes rather than relying on the arrival score alone.

Limitations & cautions

This was an observational prognostic study at two pediatric emergency departments. The outcome combined medication and restraint use, which may reflect local practice as well as patient behavior. Discrimination was moderate, the positive predictive value for high scores remained about one third, and the abstract does not establish whether using the score improves safety or reduces restrictive interventions.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatrics (PubMed). A Brief Tool to Predict Agitation in Pediatric Emergency Psychiatric Patients.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Plasmapheresis was linked to recovery in acute MOGAD attacks, but evidence was heterogeneous

Review found promising nurse-led approaches for poststroke fatigue, but study quality limited confidence

A five-item nurse triage score identified rising agitation risk in pediatric behavioral-health visits