الفهرس 
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Abstract
Summary
Traumatic brain injury (TBI) continues to be a major cause of mortality and morbidity worldwide with different challenges in the developing worlds. The burden of TBI is extremely large, with incidence ranging from 10 million persons worldwide and up to 14, 000 trauma deaths per day.
The Glasgow Coma Scale (GCS) is the most widely used scale for assessment of neurological status in patients with traumatic brain injury, have three different aspects of behavioral response to external stimulation: eye opening, motoric reaction, and verbal response.
Most important prognostic features for predicting outcome following traumatic brain injury included (early GCS score, pupil response, patient age, and CT findings).
Nurses play an important role in providing care to the brain injury patients beginning from the assessment and monitoring that require using the GCS right from the time of admission to discharge, and their care demands specialized skills and knowledge to effectively perform the GCS observations.
Aim of the study:
The aim of this study was to examine validity of Glasgow coma scale - pupil age charts in predicting discharge outcome for patient with traumatic brain injury.
Research question
Is Glasgow coma scale -pupil age charts valid in predicting the discharge outcome in patient with traumatic brain injury?
Research Design:
A descriptive exploratory research design was utilized in this study.
Setting:
The study was conducted at El-Fayoum University Hospitals in Fayoum governorate and EL-Nabawi Mohandas General hospital in the following departments: (a) neurosurgical intensive care unit, and (b) neurosurgical inpatients ward.
Subjects:
A purposive sample of (100) adult patient who were diagnosed with TBI.
Those patients were selected according to the following criteria:
Subjects should fulfill the following inclusion criteria:
1. Adult male and female patients >18 years old
2. Patients diagnosed with traumatic brain injury (mild, moderate and severe injury).
Exclusive criteria from this study:
1. Previous head injury requiring medical treatment
2. Patient under sedation
3. Pre-existing chronic disease (diabetic ketoacidosis coma, hepatic coma, &uremic coma).
Tools for Data Collection:
I. Structured interview Questionnaire (Appendix I)
It is developed by investigator to collect personal and clinical patients’ data. It consists of two parts:
Part one: it was designed to collect data about the study subjects’ demographic characteristics as age, gender, occupation, education, and marital status.
Part two: intended to collect data about the clinical presentation among studied patients as the reason for referral, date of injury, date of discharge, and mechanism of trauma.
II. Glasgow Coma Scale - Pupil Age ( Appendix II)
It adopted from (Brennan et al., 2018) the tool measures patient conscious level with consideration of pupil and patient age. The GCS evaluates three independent neurologic responses: eye opening, verbal response, and motor response, it includes assessment of eye opening (five responses), verbal response (six responses) and motor response (seven responses) and pupil responses (three responses).
III. Glasgow outcome scale (Appendix III)
Glasgow Outcome Scale (GOS) was adopted from (Jennett and Bond, 1975). The most widely used assessment of patient outcomes after head injury is the Glasgow Outcome Scale (GOS), the GOS is based upon the ability of recovering traumatic brain injury patients to perform activities of daily living and the degree of assistance required. The assessment was done once one month of discharge.
Results:
The major study findings can be summarized as the following:
- 64% of the studied patients’ age were between 18-30 years.
- In relation to gender, 77% of patients were male.
- Regarding Occupation, 43.0% were doing Non skills jobs.
- Concerning 31.0% of reason for referral was due to intracerebral hemorrhage, 25.0% due to Concussion, 21.0% due to epidural hemorrhage.
- As regards mechanism of trauma 80.0% because of road traffic accident
- Regarding Patient outcome after one month from admission 29.0% represented death, 28.0% represented good recovery, Favorable outcome occupied 53.0% but Unfavorable outcome occupied 47.0%.
- Statistically significant difference between Reason for referral and patients ‘outcomes, but show nonsignificant difference between mechanism of trauma, and patients ‘outcomes.
- Statistically significant difference between Eye opening, Verbal response, motor response, Pupils unreactive to light, Glasgow coma score and patients ‘outcomes.
- Statistically significant difference between Number of abnormal CT findings and patients ‘outcomes.
- The results revealed that Glasgow Coma Scale -Pupil Age CT charts is high significantly predicting outcomes with Sensitivity 91.5 %, and Specificity 98.1%.
In the light of the study findings, the following can be concluded:
Glasgow Coma Scale - Pupil Age charts and Computed tomography finding charts is valid and considered high significantly in predicting discharge outcomes more than Glasgow Coma Scale.
Based on the findings of this research, the following recommendations suggested:
I. Construct an educational program for nurses about GCS and GCS- PA charts in the intensive care unit to use in assessment for traumatic brain injured patients .
II. Document pupil response (size, equality, and reactivity) at admission in patient assessment record.
III. Construct educational program for nurses about brain trauma foundation guidelines related to nursing management for traumatic brain injured patients.
IV. Apply the use of GCS- PA charts in the emergency unit and neurosurgical intensive care unit .
V. Design clinical pathway for traumatic brain injured patients from admission of patients until discharge of them considering age, pupil reactivity response, and CT finding.
VI. Further studies about using GCS- PA charts in predicting outcome for traumatic brain injured patients on a larger probability sample.
VII. Perform discharge plan for traumatic brain injured patients to follow them using Glasgow outcome scale .