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      Clinical Guideline for Nursing Care of Children with Head Trauma (HT): Study Protocol for a Sequential Exploratory Mixed-Method Study

      brief-report

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          Abstract

          Background

          Head trauma is a major health problem. Its primary complications happen at the time of trauma and are inevitable; thus, head trauma management is focused on the prevention and management of secondary complications. A clear clinical guideline for head trauma care can help nurses effectively prevent and manage secondary complications. This study aims to develop the clinical guideline for nursing care of children under 18 years with head trauma hospitalized in emergency departments, critical care units, and neurosurgery wards.

          Methods

          This sequential exploratory mixed-method study will be conducted in three main phases as follows: qualitative, systematic review, and integration phases. In the qualitative phase, semi-structured interviews will be conducted to determine the care-related needs of children with head trauma. In the systematic review phase, a systematic review will be performed to find and then to review the most relevant articles, books, and the appropriate clinical guidelines. The quality of the retrieved guidelines will be assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. In the integration phase, the findings of the qualitative and systematic review phases were integrated, the draft of the guideline will be prepared, which will then be revised and validated through a nationwide Delphi survey.

          Discussion

          The guideline for nursing care of children with head trauma can help to more effectively prevent, reduce, and manage the secondary complications of head trauma. Moreover, it reduces disability and mortality rates, improves nursing care quality, decreases healthcare costs, shortens hospital stay, and makes more rational clinical decisions.

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          Most cited references21

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          The epidemiology and impact of traumatic brain injury: a brief overview.

          Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.
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            Critical care management of severe traumatic brain injury in adults

            Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, the critical care management of severe TBI will be discussed with focus on monitoring, avoidance and minimization of secondary brain insults, and optimization of cerebral oxygenation and CPP.
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              Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury.

              The objective of this study was to examine the effect of implementing a clinical practice guidelines-based management protocol on the outcome of patients with severe traumatic brain injury (TBI). We carried out a pre-post guideline implementation study using previously collected data in the Intensive Care Unit (ICU). All patients older than 12 years with severe TBI, defined as a Glasgow Coma Scale score of 8 or less, from March 1999 to January 2001 (control group) and from February 2001 to December 2006 (protocol group) were identified and included in this study. Patients in the protocol group were managed using a clinical practice guidelines-based management protocol, derived from the guidelines published by the Brain Trauma Foundation. Primary outcome was hospital mortality, whereas the secondary outcome was ICU mortality. To assess whether the ICU protocol might have led to an increase in the number of surviving patients with severe disability, we examined the association of the protocol use and the need for tracheostomies, mechanical ventilation duration, and ICU and hospital length of stay (LOS) among survivors. During the study period, a total of 434 patients met the inclusion criteria. After adjustment for several prognostic factors, the use of protocol was independently associated with a significant reduction in hospital and ICU mortality (odds ratio, 0.45; 95% confidence interval, 0.24-0.86; and odds ratio, 0.47; 95% confidence interval, 0.23-0.96, respectively). The use of the protocol was not associated with an increase in the need for tracheostomies, mechanical ventilation duration, ICU LOS, and hospital LOS. The protocol implementation was associated with a reduction in hospital and ICU mortality. This improvement was not associated with an increase in the frequency of tracheostomies and in ICU or hospital LOS, suggesting that the improved survival was not associated with the increased number of surviving patients with severe disability and that the functional status might have also improved. Copyright (c) 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Pediatric Health Med Ther
                Pediatric Health Med Ther
                phmt
                pedhlth
                Pediatric Health, Medicine and Therapeutics
                Dove
                1179-9927
                11 August 2020
                2020
                : 11
                : 269-275
                Affiliations
                [1 ]School of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan, Iran
                [2 ]Critical Care Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan, Iran
                [3 ]Children Care Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan, Iran
                [4 ]Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Pediatric Neurosurgery, Isfahan University of Medical Sciences , Isfahan, Iran
                [5 ]Department of Neurosurgery, Dezful University of Medical Sciences , Dezful, Iran
                Author notes
                Correspondence: Nasrollah Alimohammadi Critical Care Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan, Iran Email alimohammadi@nm.mui.ac.ir
                Author information
                http://orcid.org/0000-0002-7311-6894
                http://orcid.org/0000-0002-8849-7677
                Article
                260720
                10.2147/PHMT.S260720
                7429226
                32848495
                8efd9eda-4b04-451f-bfc7-a8aa2f652965
                © 2020 Kord et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 30 April 2020
                : 21 July 2020
                Page count
                Figures: 0, References: 28, Pages: 7
                Funding
                Funded by: Isfahan University of Medical Sciences, open-funder-registry 10.13039/501100003970;
                Financial support by Isfahan University of Medical Sciences, Research proposal No: 398538.
                Categories
                Study Protocol

                head trauma,nursing care,children,clinical guideline
                head trauma, nursing care, children, clinical guideline

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