Abstract

Background/Objectives: Hydration status at the time of stroke has been identified as a predictor of both vital and functional prognosis. Many studies have demonstrated that dehydration is associated with poorer outcomes, yet the prevalence of dehydration in those affected by stroke remains high. In this review, we systematically identify, appraise and summarise international clinical practice recommendations regarding hydration care after stroke. Methods: International clinical practice guidelines, published since 2009, were identified through a combination of searches of four online databases, searching of relevant websites and guidelines repositories, and citation tracking. Independent screening and data extraction were followed by quality appraisal using the AGREE II tool, and qualitative content analysis underpinned by a priori defined categories. Results: Thirteen clinical practice guidelines were included, from which 35 eligible recommendations were identified. Only seven (54%) guidelines were rated as high-quality (adequately addressing at least three AGREE II domains including “Rigour of development”). The majority of the 35 recommendations were intended for application to all stroke patients (23, 66%). Specific sub-populations, for whom hydration care was emphasised included people with dysphagia (8, 23%), immobile (2, 6%) and catheterised patients (1,3%), and those with cerebral oedema (1, 3%). Hydration care was most often discussed in the context of the avoidance and/or management of post-stroke complications, with only 8 (23%) recommendations specifically discussing hydration care alone. Of those eight recommendations, 3 (38%) suggested all stroke patients should have their hydration assessed, and 5 (62%) proposed methods of hydration management. Conclusions: The review demonstrates that international stroke guidelines recognise the importance of hydration care, although almost half of the guidelines are low to moderate quality and consider hydration in the context of post-stroke complications. Whilst hydration care, routine assessment and management of hydration status, is broadly endorsed, methods remain poorly defined. Further high-quality evidence is needed to support the development of standardised, evidence-based guidelines. Future guidelines should address the timing and methods of assessment, including the establishment of diagnostic thresholds to inform the interpretation of haematological results and subsequent treatment decisions.