Pre-Hospital Management of Brain injury in the Multi-Trauma, Blunt Head Injured Patient

2.50
Hdl Handle:
http://hdl.handle.net/10755/162633
Type:
Presentation
Title:
Pre-Hospital Management of Brain injury in the Multi-Trauma, Blunt Head Injured Patient
Abstract:
Pre-Hospital Management of Brain injury in the Multi-Trauma, Blunt Head Injured Patient
Conference Sponsor:Emergency Nurses Association
Conference Year:1999
Author:Veronica, , Oswald
Contact Address:United States Army Nurse Corps at Evans Army Community Hospital, Fort Carson, Colorado Springs, CO, 80913
Contact Telephone:USA
Purpose: With traumatic brain injury (TBI) as the leading cause of death, secondary brain insult (SBI) increases morbidity and mortality. Early, aggressive pre-hospital management aimed at prevention of such sequelae as hypotension should be instituted in all TBI patients. Little is known about the effects of pre-hospital management on patients with mild/moderate head injury (MMHI) and severe head injury (SHI). A MMHI is a patient with a Glasgow Coma Score (GCS) of 9 or greater, and a SHI is a patient with a GCS of 8 or less. This study is important because it investigated the treatment with events that occurred in the pre-hospital setting (particularly fluid resuscitation and systolic blood pressure) and compared them to the new Brain Trauma Foundation (BTF) guidelines for treatment and management of SHI patients. The purpose of this study was to compare the pre-hospital management of patients with multi-trauma, blunt, TBI with MMHI or SHI. The research questions included: what are the differences in pre-hospital care including vital signs and total volume of fluid given for multi-trauma patients with blunt TBI who have either a SHI or MMHI.

Design/Setting/Sample: A descriptive, retrospective chart review was completed by nonrandom, purposive sampling of 55 SHI and 92 MMHI pre-hospital admissions to a level one trauma center. Out of 255 records that were considered for inclusion into the study (entry into the trauma hospital data registry), 108 were excluded. Exclusion criteria involved inability to retrieve records, missing reports, incomplete records, incomplete data information, indirect transfers, penetrating head injury, no evidence of a head injury or a single injury.

Methodology: A data collection tool was developed and piloted by the investigator prior to the study. Validity was achieved by subject matter expert review and 98% intra-rater reliability. Analyses of differences were done among variables including demographics, pre-hospital conditions, survival indices, outcome scores, vital signs, and fluid amounts. Fluid resuscitation was noted to be critical in maintaining euvolemia and a primary method of preventing SBI such as hypotension in hypovolemic multi-trauma.

Results: A greater portion of SHI patients received more drugs (p=.000-.001), a higher mean amount of fluid (p=.008), and had a higher Injury Severity Score (p=.000) and head/neck body region Abbreviated Injury Score (p=.000) only than the MMHI group. A greater proportion of SHI patients had a lower mean temperature (p=.000), pre-hospital Revised Trauma Score (p=.000), Probability of Survival (p=.000), and discharge Functional Independent Measure (p=.000). A greater proportion of SHI patients dropped below 90mm Hg (18/55=33%) and the mean lowest systolic blood pressure (SBP) was lower in the SHI patients than in the MMHI patients (p=.025). [Research Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePre-Hospital Management of Brain injury in the Multi-Trauma, Blunt Head Injured Patienten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162633-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Pre-Hospital Management of Brain injury in the Multi-Trauma, Blunt Head Injured Patient</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1999</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Veronica, , Oswald</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">United States Army Nurse Corps at Evans Army Community Hospital, Fort Carson, Colorado Springs, CO, 80913</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">USA</td></tr><tr><td colspan="2" class="item-abstract">Purpose: With traumatic brain injury (TBI) as the leading cause of death, secondary brain insult (SBI) increases morbidity and mortality. Early, aggressive pre-hospital management aimed at prevention of such sequelae as hypotension should be instituted in all TBI patients. Little is known about the effects of pre-hospital management on patients with mild/moderate head injury (MMHI) and severe head injury (SHI). A MMHI is a patient with a Glasgow Coma Score (GCS) of 9 or greater, and a SHI is a patient with a GCS of 8 or less. This study is important because it investigated the treatment with events that occurred in the pre-hospital setting (particularly fluid resuscitation and systolic blood pressure) and compared them to the new Brain Trauma Foundation (BTF) guidelines for treatment and management of SHI patients. The purpose of this study was to compare the pre-hospital management of patients with multi-trauma, blunt, TBI with MMHI or SHI. The research questions included: what are the differences in pre-hospital care including vital signs and total volume of fluid given for multi-trauma patients with blunt TBI who have either a SHI or MMHI.<br/><br/>Design/Setting/Sample: A descriptive, retrospective chart review was completed by nonrandom, purposive sampling of 55 SHI and 92 MMHI pre-hospital admissions to a level one trauma center. Out of 255 records that were considered for inclusion into the study (entry into the trauma hospital data registry), 108 were excluded. Exclusion criteria involved inability to retrieve records, missing reports, incomplete records, incomplete data information, indirect transfers, penetrating head injury, no evidence of a head injury or a single injury.<br/><br/>Methodology: A data collection tool was developed and piloted by the investigator prior to the study. Validity was achieved by subject matter expert review and 98% intra-rater reliability. Analyses of differences were done among variables including demographics, pre-hospital conditions, survival indices, outcome scores, vital signs, and fluid amounts. Fluid resuscitation was noted to be critical in maintaining euvolemia and a primary method of preventing SBI such as hypotension in hypovolemic multi-trauma.<br/><br/>Results: A greater portion of SHI patients received more drugs (p=.000-.001), a higher mean amount of fluid (p=.008), and had a higher Injury Severity Score (p=.000) and head/neck body region Abbreviated Injury Score (p=.000) only than the MMHI group. A greater proportion of SHI patients had a lower mean temperature (p=.000), pre-hospital Revised Trauma Score (p=.000), Probability of Survival (p=.000), and discharge Functional Independent Measure (p=.000). A greater proportion of SHI patients dropped below 90mm Hg (18/55=33%) and the mean lowest systolic blood pressure (SBP) was lower in the SHI patients than in the MMHI patients (p=.025). [Research Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:30Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:30Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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