Measures routinely used to assess the severity and outcome of closed head injury, that is the Glasgow Coma Scale (GCS) and the duration of post-traumatic amnesia (PTA), are of limited use in the case of mild closed head injury (MCHI). The present study investigated the sensitivity of a proposed alternative measure, the Glasgow Coma Scale-Extended (GCS-E), which is a combination of GCS and PTA measures. Twenty subjects who sustai1ed MCHI were assessed with a brief battery of neuropsychological tesrs, six months after the injury. Correlations between the neuropsych1 logical measures and GCS, duration of PTA and the GCS-E were not significant, possibly because of methodological limitations. Although statistical methods do not support the notion that the GCS-E is mere sensitive than currently used measures in detecting the consequem es of MCHI, some support is obtained from qualitative observations. / Psychology / M.A. (Psychology)

Measures routinely used to assess the severity and outcome of closed head injury, that is the Glasgow Coma Scale (GCS) and the duration of post-traumatic amnesia (PTA), are of limited use in the case of mild closed head injury (MCHI). The present study investigated the sensitivity of a proposed alternative measure, the Glasgow Coma Scale-Extended (GCS-E), which is a combination of GCS and PTA measures. Twenty subjects who sustai1ed MCHI were assessed with a brief battery of neuropsychological tesrs, six months after the injury. Correlations between the neuropsych1 logical measures and GCS, duration of PTA and the GCS-E were not significant, possibly because of methodological limitations. Although statistical methods do not support the notion that the GCS-E is mere sensitive than currently used measures in detecting the consequem es of MCHI, some support is obtained from qualitative observations. / Psychology / M.A. (Psychology)

OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...

Objectives: Intracranial subdural empyema (ICSDE) can be a devastating condition, with a sequelae ranging from epilepsy, focal deficits to death. Factors affecting the outcome in subdural empyema range from level of consciousness, the extend of subdural pus at the time of diagnosis and the type of surgical procedure performed. Previous studies have conflicting results of unfavourable prognostic factors associated with ICSDE. The outcome of this condition at Steve Biko Academic Hospital (SBAH) is reported, as well as factors influencing the outcome. Methods: A retrospective analysis of all the patients admitted at neurosurgery unit of SBAH during 2006 – 2010 period with confirmed subdural empyema on brain CT scan and at surgery. Data sheet was used to collect all clinical information from patients’ records. Glasgow Outcome Scale and Henk W. Mauser grading were used to report on the outcome. Results: A total of 34 patients (20 males and 14 females) with mean age of 16.1 years were admitted with a diagnosis of ICSDE. The common presenting features were headache (58.8%), fever and seizures (47.0% each). Over 61% of patients had hemiplegia at presentation. CT scan confirmed subdural collections with 70.6% over the convexity, 23.5% at the convexity and parafalx and only 5.9% had bilateral collections. Complicated paranasal sinusitis was the origin of infection in 82.3%, followed by meningitis with 8.8%. Burr hole washout was done in 52.9% of patients, while 38.2% had burr holes with drains in situ and 8.8% had craniotomy to evacuate the subdural pus. All the patients were given empiric triple antibiotic therapy. Streptococci species were the most cultured organisms in the 19 (56.0%) patients who had positive cultures, however 15 (44.0%) patients had negative cultures. Resistance to penicillin was noted in 5.0% of cases only. Sixty-five percent of patients had good outcome with no seizures nor neurological deficits. The overall mortality was 15.0% in this study, with none from patients who had craniotomy. Conclusion: Clinical presenting features and organisms cultured seems to be the same internationally, particularly those due to complicated sinusitis. Empiric triple antibiotic therapy of 3rd generation cephalosporin plus vancomycin plus metronidazole is still relevant at SBAH. Factors associated with favourable outcome were ages between 11 and 20 years, and craniotomy as the surgical procedure of choice. / Dissertation (MMEd)--University of Pretoria, 2013. / Neurology / Unrestricted

Partindo do princípio de que existe a necessidade de padronizar os enfermeiros quanto à avaliação do nível de consciência, em pacientes atendidos no Serviço de Emergência (SE), utilizando a Escala de Coma de Glasgow (ECGl), questiona-se quais as técnicas de ensino-aprendizagem mais adequadas. O presente estudo, limitado a medir a aquisição do conhecimento nessa temática, teve como objetivos analisar duas técnicas de ensino-aprendizagem, sendo uma a de exposição oral com slides e a outra, a leitura dirigida, em enfermeiros que atuam nos SE do município de São Paulo, divididos em dois grupos, com vistas a: caracterizá-los, segundo algumas variáveis sócio-demográficas, de aperfeiçoamento profissional e de utilização da ECGl; mensurar o grau de conhecimento, utilizando um teste de conhecimentos sobre a ECGl, antes de aplicar as duas técnicas; verificar o grau de aquisição de conhecimentos, utilizando o mesmo teste de conhecimentos, após a aplicação das duas técnicas. A coleta de dados foi feita com sorteio prévio dos hospitais selecionados quanto `a técnica a ser aplicada e realizada no final de 1999 e início de 2000. Os enfermeiros dos hospitais sorteados para serem submetidos à exposição oral compuseram o Grupo 1 e à leitura dirigida, o Grupo 2. Nas características dos dois grupos de enfermeiros, verificaram-se diferenças estatisticamente significativas nas variáveis idade, tempo de formado e utilização da ECGl. Os enfermeiros do Grupo 1 eram mais jovens, com faixa etária predominante entre 22 a 25 anos (45,5%), graduados há menos de 4 anos (72,7%) e a grande maioria relatou utilizar a ECGl, às vezes (72,7%). Contrariamente, os enfermeiros do Grupo 2 tinham mais de 31 anos (86,3%) e destes, 40,9%, mais que 41 anos; estavam mais distribuídos quanto ao tempo de formado, sendo que mais da metade tinham se graduado há mais de 5 anos; e, acima de um terço (36,4%) relatou nunca usar a ECGl e 40,9%, às vezes. Homogeneidade nas demais variáveis com preponderância do sexo feminino, e solteiros, graduação em escolas da Grande São Paulo e de tempo de experiência em SE menor que 5 anos e cursos de educação continuada variada e baixa, com exceção do Basic Life Support (BLS), freqüentado por 45,5% dos enfermeiros do Grupo 1. Na mensuração do grau de conhecimento prévio dos enfermeiros, constatou-se, na totalização de pontos, os dois Grupos alcançaram mais de 50% de acertos; aqueles do Grupo 1 totalizaram 273 (62,0%) pontos de acertos de um total de 440 pontos; os do Grupo 2 perfizeram 231 (52,5%) pontos. Em relação à aquisição de conhecimentos, após serem submetidos às duas técnicas de ensino-aprendizagem, verificou-se que o Grupo 1, no global, apresentou incremento estatisticamente significativo da fase pré para a pós do processo e ele foi de 29,8%; obteve altos percentuais de acertos, em várias questões, já na fase pré e incremento de conhecimentos estatisticamente significativo, também, na maioria das questões, principalmente naquelas de aplicação prática. O Grupo 2, embora no global tenha obtido incremento estatisticamente significativo da fase pré para a pós da ordem de 8,2%, ficou inconclusivo devido à ocorrência de um importante fator interveniente, caracterizado como não leitura do texto por parte de 55,0% dos participantes. Contudo, na análise por questão, pode-se constatar que o grupo apresentou acerto em menos da metade (41,0%) das questões, na fase pré, demonstrando a precariedade da base de conhecimentos deste Grupo e a necessidade de sanar essas lacunas. Embora os resultados obtidos apontem para a superioridade da técnica de exposição oral com slides em relação à leitura dirigida, incluindo maior adesão em participar, esta conclusão deve ser interpretada com restrição, visto que a leitura para atualização não demonstrou ser uma atividade do cotidiano desses enfermeiros / Considering the fact that there is the need to standardize nurses in relation to evaluating the level of consciousness in patients attended in emergency department (ED), by making use of the Glasgow Coma Scale (GCS), one questions which teaching-learning techniques are more adequate. The present study, limited to measuring the acquisition of knowledge regarding this topic, had the objective of analysing two teaching-learning techniques, one of them through lecturing with slides and the other one through guided reading, among nurses working in ED in the city of São Paulo. These nurses were subdivided into two groups aiming at: classifying them in relation to some variables such as their social-demographic status, professional improvement and use of GCS; measuring their level of previous knowledge by giving them a test about GCS, before applying both techniques; verifying the level of knowledge acquisition using the same test, after applying both techniques. Data collection was carried out with previously-selected hospitals drawn in relation to the technique to be applied; this data collection took place between the end of 1999 and beginning of 2000. Group 1 consisted of nurses from the drawn hospitals where lecturing with slides would be applied, whereas Group 2 was involved with guided reading. When analysing both groups of nurses statistically-significant differences in relation to age brackets, how long they had been graduated for and usage of GCS arose. Nurses in Group 1 were younger, mostly between 22 and 25 (45.5%), had been graduated for less than 4 years (72.7%) and in their great majority mentioned using GCS at times (72.7%). In contrast, nurses in Group 2 were over 31 years old (86.3%) and among these, 40.9% were over 41, had been graduated for a wider range of time (more than half for over a five-year´s time), and over one third (36.4%) of the nurses in this group mentioned never using GCS while 40.9% mentioned using it at times. The other variables were more homogeneous, with a predominance of female single nurses coming from schools in Greater São Paulo with an experience at ED of less than 5 years and a variedly-low attendance in continued education courses, except for Basic Life Support (BLS), frequented by 45.5% of the nurses in Group 1. When measuring nurses´level of previous knowledge, during the adding up of points, it was revealed that both groups scored higher than 50% of the correct answers; those in Group 1 reached 273 points (62%) out of 440; those in Group 2 obtained 231 points (52.5%). In relation to knowledge acquisition, after the application of both teaching-learning techniques, it was noticed that Group 1, as a whole, presented a statistically- significant improvement of 29.8% when comparing the fases before and after the process; this group also presented high rates of correct answers in several questions already during the pre-fase and a statistically-significant increase in knowledge as well in most questions, mainly in those related to practical application. Although Group 2 as a whole presented a statistically-significant increase (8.2%), when comparing the fases before and after the process, this group remained inconclusive due to an important intervening factor: 55% of its members did not read the texts. However, when analysing each question, it became clear that less than half of the questions (41%) were correctly answered by over 50% of the members in this group during the pre-fase, a fact which shows the precariousness of their previous knowledge and the need to bridge these gaps. Even though the results obtained in this research point out the superiority of lecturing with slides in relation to guided reading, including nurses higher interest in participating, this conclusion must be interpreted in terms since reading to update knowledge does not seem to be an everyday activity for these nurses

Partindo do princípio de que existe a necessidade de padronizar os enfermeiros quanto à avaliação do nível de consciência, em pacientes atendidos no Serviço de Emergência (SE), utilizando a Escala de Coma de Glasgow (ECGl), questiona-se quais as técnicas de ensino-aprendizagem mais adequadas. O presente estudo, limitado a medir a aquisição do conhecimento nessa temática, teve como objetivos analisar duas técnicas de ensino-aprendizagem, sendo uma a de exposição oral com slides e a outra, a leitura dirigida, em enfermeiros que atuam nos SE do município de São Paulo, divididos em dois grupos, com vistas a: caracterizá-los, segundo algumas variáveis sócio-demográficas, de aperfeiçoamento profissional e de utilização da ECGl; mensurar o grau de conhecimento, utilizando um teste de conhecimentos sobre a ECGl, antes de aplicar as duas técnicas; verificar o grau de aquisição de conhecimentos, utilizando o mesmo teste de conhecimentos, após a aplicação das duas técnicas. A coleta de dados foi feita com sorteio prévio dos hospitais selecionados quanto `a técnica a ser aplicada e realizada no final de 1999 e início de 2000. Os enfermeiros dos hospitais sorteados para serem submetidos à exposição oral compuseram o Grupo 1 e à leitura dirigida, o Grupo 2. Nas características dos dois grupos de enfermeiros, verificaram-se diferenças estatisticamente significativas nas variáveis idade, tempo de formado e utilização da ECGl. Os enfermeiros do Grupo 1 eram mais jovens, com faixa etária predominante entre 22 a 25 anos (45,5%), graduados há menos de 4 anos (72,7%) e a grande maioria relatou utilizar a ECGl, às vezes (72,7%). Contrariamente, os enfermeiros do Grupo 2 tinham mais de 31 anos (86,3%) e destes, 40,9%, mais que 41 anos; estavam mais distribuídos quanto ao tempo de formado, sendo que mais da metade tinham se graduado há mais de 5 anos; e, acima de um terço (36,4%) relatou nunca usar a ECGl e 40,9%, às vezes. Homogeneidade nas demais variáveis com preponderância do sexo feminino, e solteiros, graduação em escolas da Grande São Paulo e de tempo de experiência em SE menor que 5 anos e cursos de educação continuada variada e baixa, com exceção do Basic Life Support (BLS), freqüentado por 45,5% dos enfermeiros do Grupo 1. Na mensuração do grau de conhecimento prévio dos enfermeiros, constatou-se, na totalização de pontos, os dois Grupos alcançaram mais de 50% de acertos; aqueles do Grupo 1 totalizaram 273 (62,0%) pontos de acertos de um total de 440 pontos; os do Grupo 2 perfizeram 231 (52,5%) pontos. Em relação à aquisição de conhecimentos, após serem submetidos às duas técnicas de ensino-aprendizagem, verificou-se que o Grupo 1, no global, apresentou incremento estatisticamente significativo da fase pré para a pós do processo e ele foi de 29,8%; obteve altos percentuais de acertos, em várias questões, já na fase pré e incremento de conhecimentos estatisticamente significativo, também, na maioria das questões, principalmente naquelas de aplicação prática. O Grupo 2, embora no global tenha obtido incremento estatisticamente significativo da fase pré para a pós da ordem de 8,2%, ficou inconclusivo devido à ocorrência de um importante fator interveniente, caracterizado como não leitura do texto por parte de 55,0% dos participantes. Contudo, na análise por questão, pode-se constatar que o grupo apresentou acerto em menos da metade (41,0%) das questões, na fase pré, demonstrando a precariedade da base de conhecimentos deste Grupo e a necessidade de sanar essas lacunas. Embora os resultados obtidos apontem para a superioridade da técnica de exposição oral com slides em relação à leitura dirigida, incluindo maior adesão em participar, esta conclusão deve ser interpretada com restrição, visto que a leitura para atualização não demonstrou ser uma atividade do cotidiano desses enfermeiros / Considering the fact that there is the need to standardize nurses in relation to evaluating the level of consciousness in patients attended in emergency department (ED), by making use of the Glasgow Coma Scale (GCS), one questions which teaching-learning techniques are more adequate. The present study, limited to measuring the acquisition of knowledge regarding this topic, had the objective of analysing two teaching-learning techniques, one of them through lecturing with slides and the other one through guided reading, among nurses working in ED in the city of São Paulo. These nurses were subdivided into two groups aiming at: classifying them in relation to some variables such as their social-demographic status, professional improvement and use of GCS; measuring their level of previous knowledge by giving them a test about GCS, before applying both techniques; verifying the level of knowledge acquisition using the same test, after applying both techniques. Data collection was carried out with previously-selected hospitals drawn in relation to the technique to be applied; this data collection took place between the end of 1999 and beginning of 2000. Group 1 consisted of nurses from the drawn hospitals where lecturing with slides would be applied, whereas Group 2 was involved with guided reading. When analysing both groups of nurses statistically-significant differences in relation to age brackets, how long they had been graduated for and usage of GCS arose. Nurses in Group 1 were younger, mostly between 22 and 25 (45.5%), had been graduated for less than 4 years (72.7%) and in their great majority mentioned using GCS at times (72.7%). In contrast, nurses in Group 2 were over 31 years old (86.3%) and among these, 40.9% were over 41, had been graduated for a wider range of time (more than half for over a five-year´s time), and over one third (36.4%) of the nurses in this group mentioned never using GCS while 40.9% mentioned using it at times. The other variables were more homogeneous, with a predominance of female single nurses coming from schools in Greater São Paulo with an experience at ED of less than 5 years and a variedly-low attendance in continued education courses, except for Basic Life Support (BLS), frequented by 45.5% of the nurses in Group 1. When measuring nurses´level of previous knowledge, during the adding up of points, it was revealed that both groups scored higher than 50% of the correct answers; those in Group 1 reached 273 points (62%) out of 440; those in Group 2 obtained 231 points (52.5%). In relation to knowledge acquisition, after the application of both teaching-learning techniques, it was noticed that Group 1, as a whole, presented a statistically- significant improvement of 29.8% when comparing the fases before and after the process; this group also presented high rates of correct answers in several questions already during the pre-fase and a statistically-significant increase in knowledge as well in most questions, mainly in those related to practical application. Although Group 2 as a whole presented a statistically-significant increase (8.2%), when comparing the fases before and after the process, this group remained inconclusive due to an important intervening factor: 55% of its members did not read the texts. However, when analysing each question, it became clear that less than half of the questions (41%) were correctly answered by over 50% of the members in this group during the pre-fase, a fact which shows the precariousness of their previous knowledge and the need to bridge these gaps. Even though the results obtained in this research point out the superiority of lecturing with slides in relation to guided reading, including nurses higher interest in participating, this conclusion must be interpreted in terms since reading to update knowledge does not seem to be an everyday activity for these nurses

The study aimed at giving a thick description of African families' experiences, views, cultural beliefs and interpretations of traumatic brain injury (TBI), and making recommendations for rehabilitation. It was conducted from the qualitative research paradigm, adopting a phenomenological research method. Twenty-two pairs of participants (patients and their caregivers )were interviewed about their perception of TBI. The semi-structured interviews were conducted at the participants' homes in Sesotho, and where necessary in their home languages. The consequences of TBI were found to follow universal trends (Oddy, 1984). However, participants' perceptions, as shaped by their experiences, views and cultural beliefs, were found to be unique. On analysing the gathered data, using inductive data analysis, it was found that African families' interpretations of TBI were based on beliefs about witchcraft, thwasa, Satanism, ancestral anger and God's wish. Based on these findings, rehabilitation services in the form of education, advocacy, networking and family therapy are recommended. / Psychology / M.A.(Clinical Psychology)

O traumatismo cranioencefálico (TCE) constitui um dos principais problemas de saúde pública mundial e as suas características variam de acordo com a população envolvida, sendo de suma importância o conhecimento de dados demográficos da mesma para que sejam adotadas medidas de prevenção efetivas. Tivemos como objetivos a descrição de dados demográficos e tomográficos em pacientes vítimas de TCE e a correlação entre idade, sexo, escala de Glasgow e dados tomográficos com a mortalidade em curto prazo. Neste estudo transversal e prospectivo realizado em pacientes vítimas de TCE admitidos na Unidade de Emergência Dr. Armando Lages, Maceió, Alagoas, foram incluídos 623 pacientes para descrição dos dados demográficos e 451 pacientes, para a análise de correlação; realizada por meio da Análise de Correlação de Spearman e de análise multivariada através de regressão logística. Foi constatada uma razão masculino/feminino geral de 3,54: 1 e a faixa etária mais acometida foi a de 21 a 30 anos. Os principais mecanismos do trauma foram os acidentes relacionados com meio de transporte motorizado (35,15%), as quedas (32,59%) e as agressões com ou sem armas (22,79%). As alterações mais comuns no TCE leve foram o hematoma subgaleal e/ou palpebral (48,5%), as fraturas (28,3%) e as contusões cerebrais (12,2%). No TCE moderado, as alterações mais freqüentes foram o hematoma subgaleal/palpebral (68,9%), fraturas (43,2%), contusão cerebral (33,7%) e hemorragia subaracnóide (HSA) (28,4%). No TCE grave, as anormalidades mais comuns foram a a HSA (71,1%), o hematoma subgaleal e/ou palpebral (68,9%), as fraturas (64,4%), contusões cerebrais (53,3%) e edema difuso (53,3%). As variáveis relacionadas com a mortalidade, por meio da análise univariada, foram a pontuação 3 na escala de Glasgow, presença de anormalidades tomográficas, de hematoma subdural (HSD), de HSA, apagamento/assimetria de cisternas basais, desvio da linha média, edema difuso, hemorragia intraventricular (HIV), presença de projétil ou estilhaços de arma de fogo. As variáveis sexo, faixa etária e hematoma extradural não apresentaram correlação estatisticamente significante com mortalidade neste estudo. As variáveis preditoras de mortalidade, na análise multivariada, foram valores baixos na escala de Glasgow, presença de anormalidades tomográficas, desvio da linha média e edema difuso. Em conclusão, os pacientes vítimas de TCE apresentaram uma predominância do masculino, numa razão M/F média de 3,54: 1,da faixa etária entre 21 a 30 anos e as causas mais freqüentes de TCE foram a queda de altura, o atropelamento e a agressão física. As características tomográficas mais freqüentes nos grupos de TCE leve e moderado foram: o hematoma subgaleal e/ou palpebral, fratura óssea e contusão cerebral. No TCE grave as lesões mais freqüentes foram a HSA, o hematoma subgaleal e/ou palpebral, fratura óssea, contusão cerebral e edema difuso. Os fatores relacionados com maior mortalidade na análise univariada foram: baixa pontuação na escala de Glasgow, pontuação 3 na escala de Glasgow, presença de anormalidades tomográficas, presença de HSA, presença de HSD, apagamento/assimetria de cisternas basais, desvio linha média, edema difuso, HIV e presença de projétil ou estilhaços de arma de fogo. Na análise multivariada: baixa pontuação na escala de Glasgow, presença de anormalidades tomográficas, presença de desvio da linha média, presença de edema difuso. / The traumatic brain injury (THI) is a major public health concern worldwide. Preventive measures to tackle the problem can be taken after analyzing demographic data and the types of injury affecting the population at hand. Our aim was to outline the demographic and tomographic data from THI victims and determine how tomography findings, age, gender, and Glasgow Coma Scale (GCS) are associated to short-term mortality. The THI patients in this cross-sectional and prospective study had been admitted to the Armando Lages Emergency Care Unit in Maceió, Alagoas. The study comprised 623 patients, who had been clinically diagnosed with THI. A total of 451 patients were included in the investigation into the correlation of computer tomography, age, gender, GCS, and mortality. Both the Spearman Correlation Analysis, and logistic regression multivariate analysis were used. The overall male:female ratio was 3.54, with 78.01% of the victims male and 21.99% female. Most patients fell within the 21 to 30 age bracket. Traffic accidents (35.15%) were the leading cause of head injury, followed by falls (32.59%), and physical assault (22.79%). Tomographic abnormalities were seen in 63.7% of victims of mild THI, the most common being subgaleal and eyelid hematoma (48.5%), skull fractures (28.3%), and cerebral contusion (12.2%). Moderate THI produced tomographic abnormalities in 83.4% of victims, the most frequent being subgaleal and eyelid hematoma (68.9%), fractures (43.2%), cerebral contusion (33.7%), and subarachnoid hemorrhage (SAH) (28.4%). Computer tomography of the skull showed alterations for all victims of severe THI, the most often being subgaleal and eyelid hematoma (68.9%), followed by SAH (71.1%), skull fractures (64.4%), cerebral contusion (53.3%), diffuse brain swelling (53.3%). Univariate analysis attested that a score 3 on the GCS, the presence of tomographic abnormalities, subdural hematoma (SDH), SAH, absent or compressed basal cisterns, midline shift, diffuse brain swelling, intraventricular hemorrhage (IVH), and the presence of a projectile or shell splinters had an statistically significant correlation with short-term mortality. In this study, gender, age group, and large extradural hematoma had no statistical significance as predictive factors for mortality. In a multivariate analysis, the variables that accounted for mortality were low GCS scores, the presence of tomographic abnormalities, midline shift, and diffuse brain swelling. It can be concluded that males were the predominant victims in THI cases, with the M:F ratio at 3.54. Most affected were individuals aged 21 to 30, and the most common causes of THI were falls, being run over by a vehicle, and physical assault. The most frequent tomographic characteristics in the mild and moderate THI cases were subgaleal and/or eyelid hematoma, skull fracture and cerebral contusion. The most common injuries in severe THI patients were subgaleal and/or eyelid hematoma, SAH, skull fracture, cerebral contusion, and diffuse brain swelling. The factors most closely linked to higher mortality after univariate analysis were low GCS scoring, a score 3 on the GCS, the presence of tomographic abnormalities, the presence of SAH, the presence of SDH, absent or compressed basal cisterns, midline shift, diffuse brain swelling, IVH, and the presence of a projectile or shell splinters. After multivariate analysis: low scoring on the GCS and the presence of tomographic abnormalities, midline shift, and diffuse brain swelling.

As consequências do trauma cranioencefálico contuso incluem além da mortalidade, alterações físicas, cognitivas e comportamentais que alteram a qualidade de vida das vítimas pós-trauma. A Escala de Coma de Glasgow é reconhecida na literatura científica, como um indicador com potencial para estimar o prognóstico das vítimas de trauma cranioencefálico contuso e tem sido extensivamente estudada para prever resultados a curto e longo prazos. No entanto, por tratar-se de um índice fisiológico, sujeito a oscilações decorrentes de mudanças nas condições clínicas das vítimas, esta escala suscita divergências em relação ao valor que apresenta melhor desempenho para prognosticar desfechos de interesse clinico. Perante tais divergências, este estudo teve como objetivos: verificar o desempenho dos escores da escala observados nas primeiras 72 horas, após trauma para predizer o estado vital à saída hospitalar e a mudança percebida do estado de saúde; comparar o valor preditivo desses escores para prognosticar esses desfechos e verificar a associação dos escores da Escala de Coma de Glasgow e os domínios da qualidade de vida das vitimas, após um ano do evento traumático. Trata-se de um estudo longitudinal que analisou valores da Escala de Coma de Glasgow nas primeiras 72 horas, após trauma, durante a internação hospitalar e resultados da avaliação de qualidade de vida das vítimas de trauma cranioencefálico contuso, um ano após o evento traumático. Os valores da escala analisados foram os obtidos, após a reanimação inicial intra-hospitalar, além dos piores e melhores resultados da escala nas primeiras 72 horas pós-trauma. A capacidade preditiva dos valores da escala para estado vital à saída hospitalar e a mudança percebida do estado de saúde foi avaliada, utilizando-se a curva Reciever Operator Characteristic. A qualidade de vida das vítimas foi avaliada por meio do Medical Outcome Study 36-item Short Form Health Survey (SF-36), e os resultados da Escala de Coma de Glasgow foram confrontados com os valores dos domínios dessa escala. Foram estudadas 277 vítimas, com trauma cranioencefálico contuso de diferentes gravidades. O desempenho dos escores da Escala de Coma de Glasgow para Estado Vital à Saída hospitalar foi moderado, as áreas sob a curva variaram de 0,74 a 0,79. Para a mudança percebida do estado de saúde, um ano pós-trauma, os valores dessas áreas ficaram entre 0,63 e 0,71. Não houve diferença significativa entre as áreas sob a curva nos valores da Escala de Coma de Glasgow atribuídos pós-reanimação inicial, melhores e piores resultados nas primeiras 72 horas pós-trauma, tanto ao estado vital, como ao estado de saúde atual. Correlação significativa foi observada, porém foi fraca entre os três escores da Escala de Coma de Glasgow e os domínios da SF-36: Capacidade funcional, Aspectos físicos e Aspectos sociais. O pior resultado correlacionou-se com o maior número de domínios. No geral, os resultados indicaram que qualquer um dos três valores da Escala de Coma de Glasgow analisados podem ser aplicados na prática clínica para estimar o prognóstico das vitimas de trauma cranioencefálico contuso, considerando-se, no entanto seu moderado poder discriminatório. / The consequences of blunt traumatic brain injury go beyond high mortality to include, modifications in physical, cognitive and behavioral aspects, thus altering the Quality of Life of the victims. The Glasgow Coma Scale is scientifically recognized as a potential indicator to estimate prognosis and predict short and long term outcomes of blunt traumatic brain injury victims. Although it is a physiological index, and sensitive to changes of clinical variables, the Glasgow Coma Scale attempts to cause divergence in the relationship of values that can better predict clinical outcomes. The aims of this research are, to analyze the performance of three different scores of the Glasgow Coma Scale in the first 72 hours of in-hospital assistance in predicting Hospital Mortality and changes of the health status perception after trauma; to compare the predictive performance of these scores, and correlate them to quality of life subscales after one year of trauma. The Glasgow Coma Scale, chosen in this present study, include the score obtained after initial resuscitation; the highest value and the lowest value in the first 72 hours of in hospital assistance. The capacity of prognosis of the scores, were evaluated by the Receiver Operator Characteristic (ROC) curve. Quality of life was assessed by the Medical Outcome Study- a 36-item Short Form Health Survey (SF-36). All Glasgow Coma Scale scores were confronted with SF36 subscales. This study included 277 victims of different severity blunt traumatic brain injuries. The performance of the three scores, which were analyzed to predict Hospital Mortality, was moderate, with an area under the curve between 0.74 and 0.79. The area under the curve for change of the health status perception, after one year of trauma, ranged from 0.63 to 0.71. There were no significant differences between the Glasgow Coma Scale scores studied in both analyses. A significant, but weak correlation was observed between the Glasgow Coma scale scores and the subscales of SF-36 Physical Functioning, Physical Role and Social Functioning. The worst Glasgow Coma Scale score, obtained in the first 72 hours after trauma, correlated to the dominions of the SF-36 subscales. These findings suggest that any one of the 3 scores studied, can be applied in clinical practice to predict the outcome of victims with blunt traumatic brain injuries, taking into consideration its moderate discriminatory power.

The study aimed at giving a thick description of African families' experiences, views, cultural beliefs and interpretations of traumatic brain injury (TBI), and making recommendations for rehabilitation. It was conducted from the qualitative research paradigm, adopting a phenomenological research method. Twenty-two pairs of participants (patients and their caregivers )were interviewed about their perception of TBI. The semi-structured interviews were conducted at the participants' homes in Sesotho, and where necessary in their home languages. The consequences of TBI were found to follow universal trends (Oddy, 1984). However, participants' perceptions, as shaped by their experiences, views and cultural beliefs, were found to be unique. On analysing the gathered data, using inductive data analysis, it was found that African families' interpretations of TBI were based on beliefs about witchcraft, thwasa, Satanism, ancestral anger and God's wish. Based on these findings, rehabilitation services in the form of education, advocacy, networking and family therapy are recommended. / Psychology / M.A.(Clinical Psychology)