Assessment of nurse's knowledge about Glasgow coma scale at a university hospital / Avaliação do conhecimento de enfermeiros sobre a escala de coma de Glasgow em um hospital universitário

ABSTRACT Objective To assess knowledge of nurses of emergency services and intensive care units about Glasgow Coma Scale. Methods This cross-sectional analytical study included 127 nurses of critical units of an university hospital. We used structured interview with 12 questions to evaluate their knowledge about the scale. Association of Knowledge with professionals’ sociodemographic variables were verified by the Fisher-test, χ2 and likelihood ratio. Results Most of participants were women mean aged 31.1 years, they had graduated more than 5 years previously, and had 1 to 3 years of work experience. In the assessment of best score possible for Glasgow scale (question 3) nurses who had graduate more than 5 years ago presented a lower percentage success rate (p=0.0476). However, in the question 7, which evaluated what interval of the scale indicated moderate severity of brain trauma injury, those with more years of experience had higher percentage of correct answers (p=0.0251). In addition, nurses from emergency service had more correct answers than nurses from intensive care unit (p=0.0143) in the same question. Nurses graduated for more than 5 years ago had a lower percentage of correct answers in question 7 (p=0.0161). Nurses with more work experience had a better score (p=0.0119) to identify how assessment of motor response should be started. Conclusion Number of year since graduation, experience, and work at critical care units interfered in nurses’ knowledge about the scale, which indicates the need of training.

RESUMO Objetivo Avaliar o conhecimento de enfermeiros de unidades críticas, serviços de emergência e unidades de terapia intensiva em relação à escala de coma de Glasgow. Métodos Estudo transversal e analítico com 127 enfermeiros de unidades críticas de um hospital universitário. Utilizou-se entrevista estruturada com 12 questões que avaliaram conhecimento sobre a escala. Associação do conhecimento com variáveis sociodemográficas dos profissionais foi verificada pelo teste de Fisher, teste χ2 e razão de verossimilhança. Resultados Houve predominância de mulheres, média de idade de 31,1 anos, especialistas, mais de 5 anos de formado e experiência profissional de 1 a 3 anos. Na avaliação do melhor escore possível para pontuação na escala (questão 3), enfermeiros com tempo de formação maior que 5 anos apresentaram menor porcentual de acertos (p=0,0476). Em relação à questão 7, que avaliou qual intervalo da escala indicava gravidade moderada do trauma craniencefálico, observou-se que quanto maior o tempo de experiência, maior o porcentual de acertos (p=0,0251), sendo que enfermeiros do serviço de emergência tiveram mais acertos nessa questão em relação aos das unidades de terapia intensiva (p=0,0143). Além disso, enfermeiros formados há mais de 5 anos apresentaram menor porcentual de acertos nessa questão (p=0,0161). Quando se identificou como deve ser iniciada a avaliação da resposta motora, enfermeiros com maior tempo de trabalho na unidade apresentaram mais acertos (p=0,0119). Conclusão Tempo de formação, experiência e trabalho na unidade interferiu no conhecimento de enfermeiros sobre a escala, evidenciando necessidade de capacitação.

Esquizencefalia de labio cerrado bilateral: a propósito de un caso / Schizencephaly of bilateral closed lip: speaking of one case

La esquizencefalia es un desorden de la migración neuronal, caracterizada por hendiduras de sustancia gris en los hemisferios cerebrales que se extienden desde la superficie pial a los ventrículos laterales. Esta patología es el resultado final de una amplia variedad de factores genéticos, tóxicos, metabólicos y de agentes infecciosos que ocurren durante un período crítico del desarrollo cerebral. Esta malformación puede ser unilateral o bilateral y puede ser dividida en dos subtipos: de ¨labios cerredos" o tipo I, o de "Labios abierto" o tipo II. Presentamos el caso de una paciente demenina de 37 años de edad con epilepsia y hallazgos neurorradiológicos de esquizencefalia de "labios cerrados" bilateral

Schizencephaly is a rare developmental of neuronal migration, characterized by congenital clefts spanning the cerebral hemisphere from the pial surface to the lateral ventricle and lined by cortical gray matter. The lesion is the final result of a variety of etiologies including genetic, toxic, metabolic and infectious agents during a critical period of the development of the brain. This malformation can be unilateral or bilateral and may be divided in two subtypes: "closed tips" or type I and "open tips" or type II. We present 37 years old female patient with epilepsy and neuroradiological findings of bilateral "closed lips" schizencephaly

Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral / Evaluation of 76 cases of traumatic brain injury from falling from standing height in an Emergency

Objetivo: O objetivo deste estudo foi elaborar um perfil epidemiológico de pacientes que sofreram traumatismo crânio-encefálico (TCE) por queda da própria altura (QPA). Métodos: Foram selecionados os pacientes com TCE atendidos na emergência de um hospital geral em Florianópolis (SC) durante um período de dois meses. Os pacientes que apresentaram TCE por QPA foram avaliados. As variáveis deste estudo incluíram: idade, sexo, presença de comorbidades e pontuação na Escala de Coma de Glasgow (ECG) no momento da admissão à emergência. Resultados: Setenta e seis pacientes (44 homens e 32 mulheres) preencheram os nossos critérios de inclusão. As idades dos pacientes à admissão variaram de 15 a 98 anos (média: 45,8 anos). Aproximadamente 63% dos pacientes utilizaram o carro privado como meio de transporte préhospitalar; 15% tinham história de ingestão alcoólica recente; 37% perderam a consciência imediatamente antes ou logo após o trauma e 37% tinham uma ou mais comorbidades conhecidas no momento do trauma. De acordo com a ECG, cerca de 90% dos pacientes sofreram TCE leve(ECG>12). Conclusões: A maioria dos pacientes atendidos na emergência devido a TCE por QPA são homens eindivíduos com idade superior a 40 anos. O sexo masculino está mais freqüentemente associado com uma história de ingestão alcoólica. O consumo de álcool está associado com a perda de consciência e maior gravidade do TCE. As análises demonstraram não haver relação da gravidade do TCE com osexo, a idade, a perda da consciência ou a presença de comorbidades associadas.

Objective: The aim of this study was to elaborate an epidemiological profile of patients who suffered traumatic brain injury (TBI) from falling from standing height. Methods: We selected the patients with TBI presented to the emergency room (ER) of a generalhospital in Florianopolis (Brazil) during a time period of two months. Patients who suffered TBI caused by falling from standing height were evaluated. The variables analyzed included: age, sex,presence of comorbidities and the Glasgow Coma Scale score (GCS) at the time of admission to the ER.Results: Seventy six patients (44 men and 32 women) fulfilled our inclusion criteria. Ages at admission ranged from 15 to 98 years (mean: 45.8 years). Approximately 63% of patients arrived at the hospital by private car, 15% had a history of recent alcohol consumption, 37% lost consciousness immediately before or right after the trauma, and 37% had one or more known comorbidities. According to the CGS, about 90% of patients had a mild TBI (GCS>12). Conclusions: Most patients admitted into ER with TBI from falling from standing height are men andpeople older than 40 years old. Male sex is more often associated with a history of alcohol intake. Alcohol consumption is associated with loss of consciousness and severity of TBI. The analysisdemonstrated no correlation between sex, age, loss of conscioussness or comorbidities and the severity of TBI.

Morbilidad materna aguda y severa en Guatemala / Severe acute maternal morbidity in Guatemala

Objetivo: determinar el estado de conciencia materno en la morbilidad severa y aguda durante el embarazo, parto, aborto y puerperio relacionándolo con el pronóstico y evolución al ingresar a un centro hospitalario. Diseño: estudio de seguimiento prospectivo, de base poblacional, con lugar definido geográficamente. Lugar: dos hospitales públicos y tres hospitales de la seguridad social del departamento de Guatemala. Población: 39,361 partos hospitalarios en un período de 12 meses. Método: análisis univariado, bivariado y multivariado, así como pruebas de regresión logística comparando los casos de morbilidad severa y aguda clasificadas concientes e inconscientes.

Indirect traumatic optic neuropathy--retrospective interventional case series from a tertiary care center in eastern Nepal.

To report the demography, nature of insult and ocular characteristics in patients presenting with indirect traumatic optic neuropathy and to evaluate the visual outcome with mega dose methylprednisolone therapy. Retrospective hospital data analysis of all patients admitted with indirect traumatic optic neuropathy and treated with mega dose methylprednisolone therapy in the last three years was conducted. Nine patients (M:F= 8:1) were identified with unilateral optic nerve injury. Road traffic injury was the most common cause of injury. Lid ecchymosis and swelling on the same side was the most frequent ocular abnormality noted, followed by loss of consciousness. Time of presentation varied from 3 hours to 11 days. All patients except two had visual acuity of no light perception at presentation. Following therapy there was improvement in visual acuity in two patients who presented within two days of injury. Patients present late with traumatic optic neuropathy in this hospital. Most of the patients are with no light perception. High dose steroids was found to be beneficial only in patients presenting early (<two days).

How important is history of unconsciousness in head injury patients?

A total of 100 patients of head injury were studied. They all underwent thorough clinical and neurological examination, skull radiography and CT scan of head. And with the help of all these parameters an evaluation was done to find out the importance of history of unconsciousness on risk of intracranial complications. A lot of controversies exist about detection of factors that make a patient of head injury a high risk candidate for developing intracranial complications. Young active population was the most commonly affected group in head injury with male preponderance at all ages. Roadside accident found to be the main cause of head trauma in adults while fall from height in paediatric age group. Although Glassgow Coma Index (GCI) was found to be a good predictor for intracranial complications as well as final outcome in patients with total score of 12 or less but it was not equally good in patients of minor head injury (GCI = 13-15). Similarly history of unconsciousness was not found to be correlating well with risk of intracranial complications but longer duration of unconsciousness was found to be a poor prognostic index.