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Morphet J, Innes K, Griffiths DL, Crawford K, Williams A. Resident transfers from aged care facilities to emergency departments: can they be avoided? Emerg Med Australas 2015; 27:412-8. [PMID: 26095333 PMCID: PMC4745031 DOI: 10.1111/1742-6723.12433] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
Objective Residents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations. Methods A retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be ‘potentially avoidable’. Results There were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy‐one residents (17.4%) were identified as being potentially avoidable transfers. Conclusion Many resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services.
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Affiliation(s)
- Julia Morphet
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kelli Innes
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra L Griffiths
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Allison Williams
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Liang SY, Theodoro DL, Schuur JD, Marschall J. Infection prevention in the emergency department. Ann Emerg Med 2014; 64:299-313. [PMID: 24721718 PMCID: PMC4143473 DOI: 10.1016/j.annemergmed.2014.02.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/01/2023]
Abstract
Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to health care personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, health care personnel vaccination, and environmental controls to strategies for preventing health care-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Daniel L Theodoro
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Morphet J, Griffiths DL, Innes K, Crawford K, Crow S, Williams A. Shortfalls in residents' transfer documentation: challenges for emergency department staff. ACTA ACUST UNITED AC 2014; 17:98-105. [PMID: 25113312 DOI: 10.1016/j.aenj.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Increasing numbers of residents are transferred from aged care facilities to emergency departments. Frequently, residents arrive with inadequate documentation regarding their presenting complaint or medical history, making it difficult for emergency department staff to make decisions about care. METHODS A retrospective review of emergency department records was undertaken for residents transferred from residential aged care facilities to two emergency departments in Melbourne, Victoria in 2012. RESULTS 2880 resident transfers were included in the sample, of which 408 transfers were randomly selected for documentation review. Clinically important documentation was frequently absent including: the reason for transfer to the ED (n=197, 48.2%); baseline cognitive function (n=244, 59.7%); and vital signs at time of complaint (n=285, 69.9%). When the reason for transfer was absent, residents with an altered conscious state had more investigations and spent longer in the emergency department than when the reason for transfer was recorded. CONCLUSION Inadequate documentation negatively impacted the resident's journey through the emergency department. There is evidence that inadequate documentation contributes to poor patient outcomes. To minimise the gaps in the transfer documentation regular staff development and quality assurance programs may be required in residential aged care facilities.
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Affiliation(s)
- Julia Morphet
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia.
| | - Debra L Griffiths
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Kelli Innes
- School of Nursing & Midwifery, Monash University, Berwick Campus, Clyde Road, Berwick, Australia
| | - Kimberley Crawford
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Sally Crow
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Allison Williams
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
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O'Connor M, O'Brien A, Bloomer M, Morphett J, Peters L, Hall H, Parry A, Recoche K, Lee S, Munro I. The Environment of Inpatient Healthcare Delivery and Its Influence on the Outcome of Care. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2012; 6:104-16. [DOI: 10.1177/193758671200600106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care. Background: Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety. Conclusion: There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.
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Abstract
OBJECTIVE This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission. METHODS This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression. RESULTS Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P < 0.001) and inpatient LOS (P = 0.01) but not with mortality or readmission. Longer boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01). CONCLUSIONS Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.
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Hooper SJ, Lewis MAO, Wilson MJ, Williams DW. Antimicrobial activity of Citrox bioflavonoid preparations against oral microorganisms. Br Dent J 2011; 210:E22. [PMID: 21217705 DOI: 10.1038/sj.bdj.2010.1224] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Citrox is a formulation of soluble bioflavonoids obtained from citrus fruits. The non-toxic and antimicrobial properties of natural bioflavonoids are well documented, and consequently there has been interest in the therapeutic application of these substances. OBJECTIVE To determine the antimicrobial activity of two Citrox formulations (BC30 and MDC30) with different bioflavonoid combinations against a range of oral microorganisms. METHODS The antimicrobial activity of both formulations was tested against 14 bacterial species and six Candida species. The two Citrox formulations (dilution range 0.007-8% v/v) were firstly evaluated by determining the in vitro Minimal Inhibitory Concentration (MIC) against planktonic microorganisms in a broth microdilution assay. Secondly, the ability of the same serial dilutions to inhibit microbial growth was assessed in a modified microtitre biofilm assay. RESULTS Both Citrox formulations exhibited antimicrobial activity. The BC30 formulation demonstrated greater activity than MDC30 and significantly inhibited growth of all bacterial species and most candidal species tested at a concentration of 1% (v/v) in both the broth and the biofilm assay. CONCLUSION Bioflavonoid preparations of Citrox have a broad-spectrum of antimicrobial activity against oral microorganisms, and as such have the potential to be used within therapeutic preparations for the control of the oral microflora.
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Affiliation(s)
- S J Hooper
- Oral Microbiology, School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY.
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Abstract
OBJECTIVE To estimate the prevalence of and to identify factors associated with prolonged emergency department length-of-stay (ED-LOS) for admitted children. METHODS Data were from the 2001-2006 National Hospital Ambulatory Medical Care Survey. The primary outcome was prolonged ED-LOS (defined as total ED time >8 hours) among admitted children. Predictor variables included patient-level (eg, demographics including race/ethnicity, triage score, diagnosis, and admission to inpatient bed vs intensive care unit), physician-level (intern/resident vs attending physician), and system-level (eg, region, metropolitan area, ED and hospital type, time and season, and diagnostic and therapeutic procedures) factors. Multivariable logistic regression was performed to identify independent predictors of prolonged ED-LOS. RESULTS Median ED-LOS for admitted children was 3.7 hours. Thirteen percent of pediatric patients admitted from the ED experienced prolonged ED-LOS. Factors associated with prolonged ED-LOS for admitted children were Hispanic ethnicity (odds ratio [OR], 1.76; 95% confidence interval [95% CI], 1.10-2.81), ED arrival between midnight and 8 a.m. (OR, 2.80; 95% CI, 1.87-4.20), winter season (January-March: OR, 1.81; 95% CI, 1.20-2.74), computed tomography scan or magnetic resonance imaging (OR, 1.65; 95% CI, 1.05-2.58), and intravenous fluids or medications (OR, 1.81; 95% CI, 1.10-2.97). Children requiring ICU admissions (OR, 0.29; 95% CI, 0.11-0.77) or receiving pulse oximetry in the ED (OR, 0.52; 95% CI, 0.34-0.81) had a lower risk of experiencing prolonged ED-LOS. CONCLUSIONS We found that prolonged ED-LOS occurs frequently for admitted pediatric patients and is associated with Hispanic ethnicity, presentation during winter season, and early morning arrival. Potential strategies to reduce ED-LOS include improved availability of interpreter services and enhanced staffing and additional inpatient bed availability during winter season and overnight hours.
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Santos HB, Machado DP, Camey SA, Kuchenbecker RS, Barth AL, Wagner MB. Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil. BMC Infect Dis 2010; 10:328. [PMID: 21073755 PMCID: PMC2992537 DOI: 10.1186/1471-2334-10-328] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution. METHODS A cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization. RESULTS After screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days). CONCLUSIONS The identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.
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Affiliation(s)
- Helena B Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Suzi A Camey
- Instituto de Matemática- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo S Kuchenbecker
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Afonso L Barth
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mário B Wagner
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gilligan P, Quirke M, Winder S, Humphreys H. Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department. J Hosp Infect 2010; 75:99-102. [PMID: 20381911 PMCID: PMC7132503 DOI: 10.1016/j.jhin.2010.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/13/2010] [Indexed: 11/27/2022]
Abstract
Preventing and controlling meticillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as ‘risk group’ (RG) on their arrival in the ED and were compared with ‘non-risk group’ (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9 h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.
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Affiliation(s)
- P Gilligan
- Emergency Department, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
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Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2007; 52:813-21. [PMID: 18070961 DOI: 10.1128/aac.01169-07] [Citation(s) in RCA: 427] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bahna P, Hanna HA, Dvorak T, Vaporciyan A, Chambers M, Raad I. Antiseptic effect of a novel alcohol-free mouthwash: A convenient prophylactic alternative for high-risk patients. Oral Oncol 2007; 43:159-64. [PMID: 16798063 DOI: 10.1016/j.oraloncology.2006.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 02/02/2006] [Accepted: 02/03/2006] [Indexed: 11/27/2022]
Abstract
We developed an efficacious and non-irritant mouthwash that is alcohol-free and that has a low concentration of chlorhexidine, in order to be used for preventing oral cavity infections in immunocompromised and cancer patients. The novel mouthwash solution was tested for its antimicrobial efficacy against both free floating (planktonic) and the biofilm forms of Candida albicans. The solution was also tested against Klebsiella pneumoniae, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA), using a modification of a previously published method. The activity of the novel mouthwash was also compared with that of three commercially available mouthwashes. The experimental mouthwash showed efficacy against C. albicans, both in free-floating form and in biofilm. With higher concentration of chlorhexidine, the solution was also efficacious in inhibiting the growth of K. pneumoniae, P. aeruginosa, and MRSA. The antiseptic activity of the alcohol-free mouthwash against other bacterial organisms and C. albicans was comparable to other commercially available alcohol-based mouthwash solutions. A novel alcohol-free mouthwash solution, that has low concentration of chlorhexidine, showed antiseptic effect against planktonic and biofilm forms of C. albicans and against K. pneumoniae, P. aeruginosa, and MRSA.
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Affiliation(s)
- Paul Bahna
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 402, Houston, TX 77030, United States
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Zaborina O, Kohler JE, Wang Y, Bethel C, Shevchenko O, Wu L, Turner JR, Alverdy JC. Identification of multi-drug resistant Pseudomonas aeruginosa clinical isolates that are highly disruptive to the intestinal epithelial barrier. Ann Clin Microbiol Antimicrob 2006; 5:14. [PMID: 16762075 PMCID: PMC1513249 DOI: 10.1186/1476-0711-5-14] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 06/08/2006] [Indexed: 12/01/2022] Open
Abstract
Background Multi-drug resistant Pseudomonas aeruginosa nosocomial infections are increasingly recognized worldwide. In this study, we focused on the virulence of multi-drug resistant clinical strains P. aeruginosa against the intestinal epithelial barrier, since P. aeruginosa can cause lethal sepsis from within the intestinal tract of critically ill and immuno-compromised patients via mechanisms involving disruption of epithelial barrier function. Methods We screened consecutively isolated multi-drug resistant P. aeruginosa clinical strains for their ability to disrupt the integrity of human cultured intestinal epithelial cells (Caco-2) and correlated these finding to related virulence phenotypes such as adhesiveness, motility, biofilm formation, and cytotoxicity. Results Results demonstrated that the majority of the multi-drug resistant P. aeruginosa clinical strains were attenuated in their ability to disrupt the barrier function of cultured intestinal epithelial cells. Three distinct genotypes were found that displayed an extreme epithelial barrier-disrupting phenotype. These strains were characterized and found to harbor the exoU gene and to display high swimming motility and adhesiveness. Conclusion These data suggest that detailed phenotypic analysis of the behavior of multi-drug resistant P. aeruginosa against the intestinal epithelium has the potential to identify strains most likely to place patients at risk for lethal gut-derived sepsis. Surveillance of colonizing strains of P. aeruginosa in critically ill patients beyond antibiotic sensitivity is warranted.
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Affiliation(s)
- Olga Zaborina
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - Yingmin Wang
- Department of Pathology, University of Chicago, Chicago, USA
| | - Cindy Bethel
- Clinical Microbiology Laboratories, University of Chicago, Chicago, USA
| | | | - Licheng Wu
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - John C Alverdy
- Department of Surgery, University of Chicago, Chicago, USA
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Dantas Filho VP, Falcão ALE, Sardinha LADC, Facure JJ, Araújo S, Terzi RGG. Fatores que influenciaram a evolução de 206 pacientes com traumatismo craniencefálico grave. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:313-8. [PMID: 15235737 DOI: 10.1590/s0004-282x2004000200022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A busca de fatores prognósticos para o traumatismo craniencefálico (TCE) tem sido alvo de muitos estudos nas últimas décadas. A identificação de indicadores consistentes da evolução destes pacientes tem representado um grande desafio e sua utilidade considerada evidente tanto para orientar o tratamento, quanto para a estimativa do resultado final. Baseados numa casuística de 206 pacientes com TCE grave (8 pontos ou menos pela Escala de Coma de Glasgow - ECG), estudamos a influência de vários fatores sobre a evolução dos pacientes. A gravidade inicial medida pela ECG, a presença de hipertensão intracraniana (níveis acima de 20 mmHg), o tipo de lesão intracraniana e a presença de hipoxia, hipotensão arterial e a associação de hipóxia e hipotensão arterial tiveram influência significativa sobre a evolução dos pacientes. A presença de politraumatismo (pelo menos dois sítios de lesão além do TCE) e a idade (acima e abaixo de 40 anos) não influenciaram significativamente a evolução dos pacientes desta casuística.
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Affiliation(s)
- Venâncio Pereira Dantas Filho
- Departamento de Neurologia e Neurocirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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