Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury
| Autor: | Jacqueline Mabweijano, Miriam Gamble, Josephine Nabulime, Hani Mowafi, Tonny Stone Luggya |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Referral Traumatic brain injury Low resource Vital signs lcsh:Medicine 03 medical and health sciences 0302 clinical medicine Geochemistry and Petrology Intervention (counseling) medicine Uganda 030212 general & internal medicine Nurse education Secondary brain injury lcsh:R5-920 business.industry lcsh:R 030208 emergency & critical care medicine Nursing chart medicine.disease Low resource settings Emergency medicine Emergency Medicine Original Article Emergency care lcsh:Medicine (General) Airway Monitoring tool business Gerontology |
| Zdroj: | African Journal of Emergency Medicine African Journal of Emergency Medicine, Vol 10, Iss 4, Pp 181-187 (2020) |
| ISSN: | 2211-419X |
| DOI: | 10.1016/j.afjem.2020.05.013 |
| Popis: | Introduction Throughout the world, traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality. Low-and middle-income countries experience an especially high burden of TBI. While guidelines for TBI management exist in high income countries, little is known about the optimal management of TBI in low resource settings. Prevention of secondary injuries is feasible in these settings and has potential to improve mortality. Methods A pragmatic quasi-experimental study was conducted in the emergency centre (EC) of Mulago National Referral Hospital to evaluate the impact of TBI nursing education and use of a monitoring tool on mortality. Over 24 months, data was collected on 541 patients with moderate (GCS9-13) to severe (GCS≤8) TBI. The primary outcome was in-hospital mortality and secondary outcomes included time to imaging, time to surgical intervention, time to advanced airway, length of stay and number of vital signs recorded. Results Data were collected on 286 patients before the intervention and 255 after. Unadjusted mortality was higher in the post-intervention group but appeared to be related to severity of TBI, not the intervention itself. Apart from number of vital signs, secondary outcomes did not differ significantly between groups. In the post-intervention group, vital signs were recorded an average of 2.85 times compared to 0.49 in the pre-intervention group (95% CI 2.08-2.62, p ≤ 0.001). The median time interval between vital signs in the post-intervention group was 4.5 h (IQR 2.1-10.6). Conclusion Monitoring of vital signs in the EC improved with nursing education and use of a monitoring tool, however, there was no detectable impact on mortality. The high mortality among patients with TBI underscores the need for treatment strategies that can be implemented in low resource settings. Promising approaches include improved monitoring, organized trauma systems and protocols with an emphasis on early aggressive care and primary prevention. |
| Databáze: | OpenAIRE |
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