Assessment of Contributing Factors to Patient's Head Trauma and it's Relation to their Outcomes at-Al Hilla Teaching Hospital
حسن علوان بيعي, شذى سعدي محمد, وفاق مهدي هادي
كلية التمريض-جامعة بابل · العراق
Head Trauma (HT) is a major cause of lifelong disability and death worldwide, but it is considered a ‘silent epidemic’ as society is largely unaware of the magnitude of the problem. Globally, approximately 10 million individuals experience head trauma every year, especially among young adults. Objectives: The study aims to assess the contributing factors to patients with head trauma, to find out the relationship between patients’ head trauma and their demographic characteristics, and to determine the association between patients’ head trauma and its outcomes. Methodology: A descriptive analytic study design was carried out to assess the contributing factors to head trauma patients and their relation to outcomes in AL-Hilla Teaching Hospital for the period of September 26th, 2017 to September 10th, 2018. To achieve the objectives of the study, a non-probability purposive sample consisting of 100 patients was selected from the emergency department according to specific criteria. Data were collected from April 10th, 2018 to July 30th, 2018, using a designed questionnaire through direct face-to-face interviews. The questionnaire is divided into four parts: Part I: Demographical data which include age, gender, level of education, occupation, and residency. Part II: Contributing factors of head trauma, including: Road Traffic Accidents (RTA) composed of automobile, cyclist, truck, pedestrian, and passenger. Falls accidents, including fall from height and other falls or jumps. Assault accidents, including assault by blunt object and assault by sharp object. Missile accidents, including shell and bullet injuries. Other contributing factors: alcohol consumption, drug abuse, systemic illness, and time of accidents. Part III: Head trauma assessment, including bleeding, associated injuries, convulsions, computed tomography (CT) scan, and operation. Part IV: Scales to measure the level of consciousness (GCS) and Glasgow Outcome Scale (GOS). The validity of the questionnaire was obtained by review from 10 experts in different fields. Cronbach’s alpha was used to calculate the reliability of the study questionnaire, which recorded 0.70 and is statistically accepted. The statistical package SPSS (version 25) was used to analyze the data. Results: The majority of the study sample (89.0%) were male, and 50.0% were middle-aged adults (18–28 years), with a low educational level. The results also showed that the most common contributing factor to head trauma was automobile accidents, recorded in 35% of cases. Severe head trauma (GCS 3–8) was recorded in 53.0% of cases, and poor outcomes, including death, occurred in 58.0% according to the Glasgow Outcome Scale. All these factors were positively and significantly associated with the development of head trauma. Conclusions: The type of head trauma varies from one society to another according to many factors, such as geographical construction, religious and cultural background, or other factors; however, the principles of management are the same, while preventive measures may differ. Adolescents to young adult male patients who are illiterate and non-governmental employees residing in urban areas of Babylon Governorate were more exposed to head trauma due to automobile accidents, which recorded the highest ratio in this study. Severe head trauma patients with bleeding from the mouth and chest injuries associated with epileptic seizures were identified as subdural hematomas. Their hospitalization was between 1–5 days, and no surgical intervention was performed. Death is the most likely outcome when the patient is exposed to these injuries. Contributing factors in terms of RTA, falls, assault, and missiles have been influential for the patients and their outcomes. Recommendations: Head trauma is a major problem responsible for high rates of mortality and morbidity worldwide. The study recommends: Assessment of patients with severe traumatic brain injury is critical, and nurses are responsible in this field. GCS and GOS assessment should be utilized as a guide for nurses in NICU centers to assess and predict the level of consciousness and outcomes of patients. Traffic directorate regulations regarding the legal age of driving should be enforced, and penalties for non-compliance should be increased.