Jurnal internasional afrika vol.10 issue 4 2020
African Journal of Emergency Medicine
Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury
Dublin Core
Title
Jurnal internasional afrika vol.10 issue 4 2020
African Journal of Emergency Medicine
Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury
African Journal of Emergency Medicine
Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury
Subject
Uganda
Secondary brain injury
Emergency care
Traumatic brain injury
Low resource settings
Nursing chart
Secondary brain injury
Emergency care
Traumatic brain injury
Low resource settings
Nursing chart
Description
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 inter-
vention, 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 in-
clude improved monitoring, organized trauma systems and protocols with an emphasis on early aggressive care
and primary prevention.
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 inter-
vention, 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 in-
clude improved monitoring, organized trauma systems and protocols with an emphasis on early aggressive care
and primary prevention.
Creator
Miriam Gamble, Tonny Stone Luggy, Jacqueline Mabweijano, Josephine Nabulime, Hani Mowafi
Source
https://doi.org/10.1016/j.afjem.2020.05.013
Date
29 May 2020
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Miriam Gamble, Tonny Stone Luggy, Jacqueline Mabweijano, Josephine Nabulime, Hani Mowafi, “Jurnal internasional afrika vol.10 issue 4 2020
African Journal of Emergency Medicine
Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1837.
African Journal of Emergency Medicine
Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1837.