CORE Metadata, citation and similar papers at core.ac.uk Provided by Ners Unair Repository RISKS FACTORS OF CLIENT OUTCOME WITH HEAD INJURY Nurul Bariyyah, Rizky Meuthia Pratiwi, Hery Sasongko, Candra Adi Wirawan Faculty of Nursing Airlangga University Email: [email protected] ABSTRACT Introduction: head injury is one of the causes of mortality and morbidity. Several studies mention predictors over outcome. The objective of this systematic review is to explore and synthesis factors which contribute to client outcome with head injury. Method: source of articles used was obtained from the search through data base which includes Pro Quest, PubMed, and EbscoHost. This search is confined from 2006 to 2016. Subsequently, the journals were reviewed for systematic review. Result: there were 10 articles reviewed. Significant risk factors of head injury include socio demographic factors such as old age, male sex, low education level, clinical factor (GCS), injury due to road traffic accident, hypotension, hypoxia, increased intracranial pressure, absence of pupillary reaction, hypo and hyperglycemia, coagulopathy, hypo and hyperthermia, abnormal electrolyte level, episode of coma, result of intracranial lesion CT scan. Conclusion: outcome predictor in a patient with head injury will be useful in Triage criteria, prognosis of injury, care and discharge planning, the use resources and patient and family counseling Keyword: risk factor, outcome, head injury INTRODUCTION client outcome with head injury, it can be Head injury is the most cases in the used to develop management system and world. Data center for disease control and Triage for clients with head injury so that it prevention (CDC) based on the emergency can be reduce mortality and morbidity visit, hospitalization, and mortality resulting from head injury. Therefore, the resulting from 2001 to 2010 shows annual objective of this systematic review is to increase. There were 823,7 per 100.000 evaluate articles for subsequently drawing cases of head injury. Head injury is one of conclusion of factors that can be used to the most causes of mortality and morbidity. predict client outcome based on evidence Several studies explain significant factors based practice. contributing to outcomes after head injury. Demographic parameter such as sex or METHODS clinical condition such as severity of injury, Methodology used in this pupilary reflex, CT scan and laboratory systematic review as preceded by topic results are taken into account as strong selection, then keyword was determined to predictors of patient with head injury. search journals in English though some data These factors can be used to evaluate base which includes PubMed and Pro chances for client survival and can be the Quest, EbscoHost, Scopus. This search was management guidelines (Xu et al, 2007 in confined from 2006 to 2016. the key words Kim, 2011) were traumatic brain injury, OR head This can be basis for correct and trauma OR head injury and predictor OR immediate neurological criteria in factor OR prognosis. Articles selected for emergency room. Moreover, prognosis can review ware based on studies conforming be used as counseling for clients and inclusion criteria. Inclusion criteria in this families in critical condition (Perel et al, systematic review were primary research 2006). By recognizing the factors affecting articles in English. The subjects were 73 8th International Nursing Conference “Education, Practice And Research Development In Nursing” humans without age limitation, sex, and hyperthermia, low hemoglobin, ethnicity with severe head injury. Outcome coagulopathy, high lactate level, electrolyte prediction was good during hospitalization imbalance, subarachnoid, epidural, or or one year after head injury. Outcome subdural bleeding. prediction at least consisted of two Few number of clients aging 65 variables. Exclusion criteria were case years old manage to survive after head report, article review, and multiple injury. injury (Calvin, 2012). Therefore, it can be Glasgow coma scale (GCS) consists of synthesized that all elderly clients with mild three components: 1) eye response, 2) injury should undergo Triage in emergency verbal response, and 3) motoric response. room for rapid and serial assessment. Total GCS is one of the considerations for In general, severity of injury is one predictor in this review. of the important factor of client outcome The search by using the keyword post injury. GCS is a tool commonly used above found ten articles that meet the in many studies. Some studies examine inclusion criteria. Then the sixteen articles components of GCS such as motoric or were reviewed, synthesized, and presented verbal response particularly with lesion. in a table. For initial assessment, GCS may be slightly neglected and sedative medication can RESULTS affect results of GCS measurement Upon screening, 10 journals particularly for patient with narrow gap meeting inclusion and exclusion criteria between moderate and mild head injury. were obtained. Most of the studies were Therefore, GCS must be done in serial conducted in Europe and USA. Glasgow fashion although the client has been stable Outcome Scale (GOS) measured within six and is evaluated with CT scan. months or one year after head injury was Although GCS has limitation found the most. Some variables are associated with a number of symptoms discussed in the research articles. (Udekwu et al.2004, Davis et al.2005), it is Significant predictor of the multivariate still recommended to be used as a method analysis result is explained in synthesis in evaluating level of consciousness in a articles. Table 1.1 shows summary client with head injury (Luk et al 1999, predictor upon outcome of head injury after Udekwu et al.2004). insufficient oxygen discharge. The elderly, severe injury, supply to the brain can directly contribute absence of pupillary reaction, hypotension to unexpected incident; for example, or hypertension, increased intracranial decreased blood flow to the brain causes a pressure, hypoxia, hyperglycemia or number of pathophysiologic event post hypoglycemia, hypothermia or head injury, including increased hyperthermia, low hemoglobin, intracranial pressure, brain vasospasm or coagulopathy, high lactate level, CT scan of systematic hypotension. Several studies subarachnoid, epidural, or subdural found significant association between bleeding were identified as factors affecting systematic secondary symptoms (hypoxia, bad outcome (GOS) in the three studies. hypotension, and hypothermia) post head injury and bad client outcome (Van Beek et DISCUSSION al. 2007, Fabbri et al. 2008). Therefore, it is This systematic review discussed important to stay alert in initial assessment some studies examining factors although outcome has been monitored contributing to client outcome with head (McHugh et al. 2007). injury. Factors affecting bad outcome Mechanism of head injury is one (Glasgow coma scale) which includes the factor associated with client outcome (Tien elderly, severe injury, absence of pupillary et al, 2006). Mechanism of injury affects reflex, blood pressure, hypothermia or consciousness before and after surgery. 74 8th International Nursing Conference “Education, Practice And Research Development In Nursing” Passengers who suffer from head injury due Knowing abnormality through surgical to road traffic accident with high speed procedure in SAH or SDH cases is vehicle do not develop lucid interval and is important for management of acute brain in prolonged comatose after surgery than injury. In addition, study of clinical history traumatic clients with low speed vehicle. and CT scan scoring is recommended for This injury indicated as diffused head evaluation and improving prognosis for injury. head injury. Abnormal parameter of laboratory The scope of this study covers study during admission is an important studies with two predictors. Therefore, it is outcome predictor post head injury. likely that there will be some misses in the Laboratory parameter is considered articles related to the use of multivariate to objective, regularly measured, and very analyze individual predictor, and estimation important. Abnormal value can be is not reported in the abstract. In some corrected with treatment to cover non- articles reviewing GOS over outcome. modifiable parameter such as age, and Some articles predict GOS for six months radiology results (Van Beek et al. 2007). and the other seven articles predict GOS for Although hyperglycemia or hypoglycemia, twelve months. This review does not divide coagulophaty, anemia, acidosis, or predictors into two groups of articles hyperthermia are important markers of because it may cause bias leading to study severity, it is important to focus on of outcome that is only based on the six incidence and abnormal correction months. parameter. Studies evaluate further benefit, GOS take stable condition into and initial parameter correction is account in six months post injury suggested in randomizes clinical trial. (Hukkelhoven et al. 2006), so this Classification of CT Marshal is a limitation is considered insignificant. This strong prognosis tool to determine client review does not analyze bias even though outcome with head injury. Classification of bias can affect accuracy of prediction of a CT Marshal uses CT scan finding at study. Also, this review does not compare mesencephalic level, middle line predictor based on countries that may be movement, and the presence or absence of important in exploring