Prognosis of Patients With Traumatic Brain Injury After Implementation of a Nurse Assessment Protocol


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Abstract

Background: The prognosis of a patient with traumatic brain injury (TBI) depends on the severity of the injury, the patient’s level of consciousness upon admission, and differences in treatment protocols. Aim: The aim of this study was to analyze the prognosis of TBI victims after implementation of a nurse assessment protocol. Method: This is a blind, nonrandomized clinical study carried out at a public emergency hospital in the state of Sergipe, Brazil. Results: The study involved 480 patients with an average (SD) age of 35.7 (±16.6) years. Most of the patients were male (p = .02). In the preprotocol and postprotocol groups, motorcycle accidents (p = .023) were more frequent, with a 10.2% death rate. The clinical conditions associated with TBI and the tomographic findings were not affected in either the preprotocol or postprotocol groups (p = .07). There was a significant reduction (p = .05) in death rate from 12.6% to 7.3% and a decrease in the percentage of discharge with aftereffects from 32.8% to 22.8%. Factors independently associated with mortality were as follows: approximately 2.5 times more likely to not apply the protocol associated with an increased chance of death, followed by a 23 times higher risk of TBI severity, and age, with an odds ratio of 1.04. Conclusions: Implementing the protocol, there was a reduction of death rate of patients with severe TBI and aftereffects in patients with moderate TBI. The severity of TBI was the main independent predictive determinant of mortality, followed by nonuse of protocol and age.

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