Translation, adaptation and validation of the full outline of unresponsiveness scale into brazilian portuguese / Traducción, adaptación y validación de la escala full outline of unresponsiveness al portugués de brasil / Tradução, adaptação e validação da escala full outline of unresponsiveness para o português do brasil

ABSTRACT Objective: to translate, culturally adapt and validate the Full Outline of UnResponsiveness scale into Brazilian Portuguese. Method: a methodological study carried out at the Clinical Hospital of Universidade Federal do Triângulo Mineiro, Uberaba, Brazil, through the following stages: translation, synthesis, evaluation by the experts' committee, back-translation, consensus, semantic evaluation and pre-test. A sample of 188 adult patients was reached. Data collection took place between August and December 2020. Concurrent criterion validity was analyzed by comparing the Full Outline of UnResponsiveness scale with the Glasgow Coma Scale by means of Spearman's and Pearson's correlation coefficients; and predictive validity analysis was performed with Cox Regression, Sensitivity and Specificity and Area Under the Receiver Operating Characteristic Curve. The Cronbach's alpha, weighted Kappa and Intraclass Correlation coefficients were also adopted for interobserver reliability. Results: Spearman's test for the motor and eye response items, respectively, resulted in 0.81 and 0.96, and Pearson's test for the total score was 0.97. A relative risk of 0.80, 95.5% specificity, 51.6% sensitivity and accuracy of 0.80 (95% CI: 0.688-0,905, p<0.001) were obtained. Cronbach's alpha was 0.94, weighted Kappa varied from 0.89 to 1.0, and ICC resulted in 0.99. Conclusion: the Full Outline of UnResponsiveness scale (Brazilian version), maintained four domains and the 20 items from the original scale, making it appropriate for use in Brazil and contributing to the assessment of the level of consciousness and prognosis of adult patients in severe conditions.

RESUMEN Objetivo: traducir, adaptar culturalmente y validar la escala Full Outline of UnResponsiveness al portugués de Brasil. Método: estudio metodológico realizado en el Hospital de Clínicas de la Universidade Federal do Triângulo Mineiro, Uberaba, Brasil, por medio de las siguientes etapas: traducción, síntesis, evaluación a cargo del comité de especialistas, retrotraducción, consenso, evaluación semántica y prueba previa. Se llegó a una muestra de 188 pacientes adultos. La recolección de datos tuvo lugar entre agosto y diciembre de 2020. Se analizó la validez de criterio concurrente comparando la escala Full Outline of UnResponsiveness con la Escala de Coma de Glasgow por medio de los coeficientes de correlación de Spearman y Pearson, y el análisis de la validez predictiva se efectuó con la Regresión de Cox, Sensibilidad y Especificidad y Área por debajo de la Curva Receiver Operating Characteristic. También se adoptaron el alfa de Cronbach y los coeficientes Kappa ponderado y de Correlación Intraclase para determinar la confiabilidad interobservador. Resultados: en la prueba de Spearman para los ítems de respuesta motora y respuesta ocular, respectivamente, se obtuvieron valores de 0,81 y 0,96, y el coeficiente de Pearson para la puntuación total fue de 0,97. Se obtuvo un riesgo relativo de 0,80, especificidad del 95,5%, sensibilidad del 51,6% y precisión de 0,80 (IC 95%: 0,688-0,905, p<0,001). El alfa de Cronbach fue de 0,94, el índice Kappa ponderado varió entre 0,89 y 1,0 y el resultado del ICC fue 0,99. Conclusión: la escala Full Outline of UnResponsiveness (Versión brasileña), mantuvo cuatro dominios y los 20 ítems de la escala original, lo que la hace apropiada para ser utilizada en Brasil y contribuye a la evaluación del nivel de consciencia y del pronóstico de pacientes adultos en condiciones de gravedad.

RESUMO Objetivo: traduzir, adaptar culturalmente e validar a escala Full Outline of UnResponsiveness para o português do Brasil. Método: estudo metodológico realizado no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba, Brasil, por meio das etapas: tradução, síntese, avaliação pelo comitê de especialistas, retrotradução, consenso, avaliação semântica e pré-teste. Alcançou-se uma amostra de 188 pacientes adultos. A coleta de dados ocorreu entre agosto e dezembro de 2020. Analisou-se a validade de critério concorrente comparando a escala Full Outline of UnResponsiveness com a Escala de Coma de Glasgow por meio dos coeficientes de correlação de Spearman e Pearson, e a validade preditiva com a Regressão de Cox, Sensibilidade e Especificidade e Área Sob a Curva Receiver Operating Characteristic. Adotaram-se, também, o alfa de Cronbach e os coeficientes Kappa ponderado e de Correlação Intraclasse para a confiabilidade interobservador. Resultados: o teste de Spearman para os itens resposta motora e ocular, respectivamente, resultou-se em 0,81 e 0,96, e o de Pearson para o escore total em 0,97. Obteve-se um risco relativo de 0,80, especificidade de 95,5%, sensibilidade de 51,6% e acurácia de 0,80 (IC95%: 0,688-0,905, p<0,001). O alfa de Cronbach foi de 0,94, o Kappa ponderado variou entre 0,89 e 1,0 e o ICC resultou em 0,99. Conclusão: a escala Full Outline of UnResponsiveness - versão brasileira, manteve quatro domínios e os 20 itens da escala original, tornando-se apropriada para utilização no Brasil e contribuindo para a avaliação do nível de consciência e prognóstico de pacientes adultos em condição grave.

Bispectral index monitoring correlates with the level of consciousness in brain injured patients / 대한마취과학회지

BACKGROUND: In general, measuring the level of consciousness in neurological patients is important. To assess the patient's mental status, the Glasgow Coma Scale (GCS) and the level of consciousness (drowsiness, stupor, and coma) have been used in clinical situations. The aim of the present study was to identify the correlation between bispectral index (BIS) and level of consciousness in brain injured patients. METHODS: Eighty-nine adult patients of both sexes were included in the study. A blinded observer evaluated the mental status (GCS and level of consciousness) of a patient who is admitted in intensive care unit with brain injury, while an investigator noted the patient's BIS. The BIS was measured using a BIS monitor, Model A-3000 vista(TM) with Sensor Bis quatro(TM) (Aspect Medical Systems, Norwood, USA). A Spearman's rank correlation coefficient was used to determine if the level of consciousness correlated with the BIS. RESULTS: In 89 patients, the BIS was found to be significantly correlated with the level of consciousness (r = 0.723, P < 0.01) and GCS (r = 0.646, P < 0.01). The BIS values increased with an increasing level of consciousness. Mean BIS values of coma, semicoma, stupor and drowsiness were 0.14 +/- 0.23, 38.9 +/- 18.0, 60.3 +/- 14.5, and 73.6 +/- 16.5, respectively. CONCLUSIONS: In the present study, a significant correlation existed between level of consciousness and BIS. These findings suggest that BIS may be used for assessing the level of consciousness in brain injured patients. However, the scatter of BIS values for any level of consciousness limited the worth of BIS in predicting mentality except in coma patients.

Relación entre los accidentes oculares ocurridos en los talleres del Instituto Técnico Industrial Piloto De Bogotá y los modelos mentales y niveles de conciencia de los estudiantes / Relationship between the eye accidents in the workshops of the Instituto Tecnico Industrial Piloto in Bogota and the mental models and consciousness levels of the students

Tomando como referente la teoría del enfoque humanista en Salud Ocupacional y para conocer las percepciones de los estudiantes que rotan por los talleres del Instituto Técnico Industrial Piloto de Bogotá, frente a los factores individuales que pueden desencadenar accidentes visuales se realizó una encuesta con cuatro preguntas abiertas, a una muestra de 60 estudiantes, para determinar los modelos mentales más predominantes y sus niveles de conciencia frente a los accidentes, Para el tratamiento de esta información se hizo un análisis cualitativo basado en la triangulación de la información utilizando categorías y subcategorías de las respuestas además, se aplicó un análisis cuantitativo sobre estos datos cualitativos a través de estadística descriptiva.Se encontró que el Autocuidado es importante, para los estudiantes. Ellos reportan que no se han accidentado por la experiencia que tienen en el taller y que además siguen las normas por protección y seguridad para sus ojos. Los grados o niveles de conciencia son importantes dentro de los modelos mentales que se evidenciaron en las respuestas dadas , por ejemplo el mágico se observó en la respuesta: -“Por suerte, o porque uno trata de tener precaución con las cosas”; el rígido y normativo se vio en la expresión “Si, porque en este taller es importante seguir las normas” y el de conciencia crítica, reflejado en las respuestas como: “Si, por seguridad y además por mantener bien mi salud visual y física”. -“Si lo hago para cuidarme físicamente y no hacerme daño” -“Si, porque de pronto nos ocurra un accidente que nos pueda causar grandes lesiones”. Finalmente, se puede decir que el evaluar los factores individuales de los estudiantes es importante para la elaboración de cualquier capacitación o programa relacionado con peligros, riesgos y accidentes oculares.

A survey with four open questions was carried outto 60 students of the workshops at the InstitutoTécnico Industrial Piloto de Bogotá, within thehumanistic approach in Occupational Health inorder to know students’ perceptions regardingindividual factors that may cause eye accidents andalso to determine the most prevailing mental modelsand their levels of consciousness in relation toaccidents. A qualitative analysis, based on thetriangulation of information, was carried out usingcategories and subcategories in the answers. Besides,a quantitative analysis was applied to this qualitativedata trough descriptive statistics. It was found thatself-care is important for students. They say thatthey have not had any accidents because of theirexperience in the workshop and because they followthe protection and security regulations for their eyes.Consciousness levels are important within themental models seen in their answers. For example,the magic model was seen in the following answer:®because you are lucky or because you are cautiouswith things¼; the rigid and regulatory model wasappreciated in the statement: ®because in thisworkshop it is important to follow the rules¼; andthe critic consciousness was expressed in thefollowing answers: ®because of safety and to caremy visual and physical health¼, ®to take care ofmyself and not hurt me¼, ®because an accident maysuddenly happen and it may causes us seriousinjuries¼. Finally, it is important to evaluatestudents’ individual factors to plan any training orprogram related to dangerous situations, risks andeye accidents.

Hypertensive Cerebellar Hemorrhage:Prognostic Factors

Hypertensive cerebellar hemorrhage was rarely diagnosed in the past and therefore thought to be infrequent, but after the introduction of computerized tomography(CT) scans it has been more commonly diagnosed. We present 36 patients with hypertensive cerebellar hemorrhage who were treated in our hospital from June 1989 to January 1994. There were 15 men and 21 women, with ages ranging between 34 and 91 years. The volume of cerebellar hematoma and the grade of quadrigeminal cisternal obliteration on CT scans significantly correlated to the level of consciousness at admission. Several prognostic factors which might influence the outcome were statistically analysed:the level of consciousness at admission, the volume of hematoma, the treatment modality, the presence of hydrocephalus, the presence of quadrigeminal cisternal obliteration on CT scans, and the location of hematoma. Overall mortality rate was 13.9% and many of the above factors affected the outcome except for the treatment modality and the presence of hydrocephalus. The outcome in patients with GCS scores of 14 or 15 at admission was excellent. We conclude that the level of consciousness at admission is the most important prognostic factor and surgical decompression is indicated particularly in patients with an impaired level of consciousness, provided that brainstem reflexes are still intact. An accurate monitoring of the patient's clinical status is very important since its worsening is an absolute indication for surgery independent of the size of hematoma.

Prognosis of Spontaneous Cerebellar Hemorrhage

The authors analyzed 34 cases of spontaneous cerebellar hemorrhage which was diagnosed by brain CT scan, and assessed the relationship of outcome to the volume of hematoma, location of hematoma, level of consciousness and the CT apperance of the quadrigeminal cistern. The results were summerized as followed : 1) Hydrocephalic changes were observed in 25 patients(73.5%) and were identidied in 21 patients of the 22 patients with intraventricular extension of gemorrhage. 2) The volume of cerebellar hematoma sigificantly correlated to the level of consciousness on admission and prognosis. Patients with large hematoma showed poor prognosis. 3) Obliteration of quadrigeminal cistern on brain CT scan significantly correlated to the level of consciousness and prognosis. The patient with complete obliteration of quadrigeminal cistern on CT scan revealed unfavorable outcome. 4) The level of consciousness was the most important prognostic factor and the decreased level of consciousness was the indicator of poor result. 5) The location of hematoma did not correlated to the prognosis.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.