Contribuições práticas do processo de enfermagem relacionado ao traumatismo cranioencefálico: Uma revisão integrativa / Practical contributions of the nursing process in traumatic brain injury: An integrative review

Introdução: O traumatismo cranioencefálico é um evento incapacitante e de importância mundial com expressiva morbimortalidade mundial. Objetivo: analisar as evidências científicas internacionais sobre o processo de enfermagem no cuidado ao adulto com traumatismo cranioencefálico. Método: Revisão integrativa, realizada em seis bases de dados de fevereiro a março de 2020. Os descritores ''pacientes internados'', ''cuidados críticos'', ''cuidados de enfermagem'', ''processo de enfermagem'', ''traumatismos craniocerebrais'' e ''traumatismo múltiplo'' foram cruzados por meio de operadores booleanos AND e OR. Os estudos foram analisados pelo método de redução de dados, contrapondo-se, o que gerou a síntese. Resultados: Ressalta-se o monitoramento hemodinâmico, a aplicação da escala de coma de Glasgow e a atualização de um plano de cuidados como parte do processo de enfermagem. Além disso, cabe-se destaque a necessidade de elaboração dos diagnósticos e intervenções de enfermagem. Conclusão: Existe uma lacuna com relação a formulação de diagnósticos de enfermagem e intervenções ligadas ao processo de enfermagem, como também a descrição dos parâmetros ideais a serem verificados na monitorização das pessoas.

Introducción: El traumatismo craneoencefálico es un acontecimiento incapacitante de importancia mundial, con una importante morbilidad y mortalidad en todo el mundo. Objetivo: Analizar las evidencias científicas internacionales sobre el proceso de enfermería en el cuidado de personas adultas con lesión cerebral traumática. Método: Revisión integradora, realizada en seis bases de datos, de febrero a marzo de 2020. Los descriptores fueron "pacientes hospitalizados", "cuidados críticos", "cuidados de enfermería", "proceso de enfermería", "lesión cerebral traumática" y "lesión cerebral traumática múltiple". Se cruzaron mediante los operadores booleanos AND y OR. Los estudios se analizaron mediante el método de reducción de datos y la contrastación generó la síntesis. Resultados: Se destaca la monitorización hemodinámica, la aplicación de la escala de coma de Glasgow y la actualización de un paquete de cuidados como parte del proceso de enfermería. Además, hay que destacar la necesidad de elaborar diagnósticos e intervenciones de enfermería. Conclusión: Existe un vacío en cuanto a la formulación de diagnósticos e intervenciones vinculado al proceso de enfermería, así como en la descripción de los parámetros ideales que deben verificarse en el seguimiento de personas.

Introduction: Traumatic brain injury is a disabling event of worldwide importance with significant morbidity and mortality worldwide. Objective: The aim was to analyze the international scientific evidence on the nursing process of caring for adult patients with traumatic brain injury. Method: This was an integrative review conducted from February to March 2020 in six databases. The descriptors "hospitalized patients", "critical care", "nursing care", "nursing process", "traumatic brain injury" and "multiple traumatic brain injury" were matched through the Boolean operators AND/OR. The studies were analyzed through a data reduction method: they were contrasted with each other. This in turn generated the synthesis. Results: The results highlight the hemodynamic monitoring, the application of the Glasgow coma scale, and the update of a care package as part of the nursing process. Furthermore, the results also highlight the need to develop nursing diagnoses and interventions. Conclusion: There is a gap regarding the formulation of nursing diagnoses and interventions linked to the nursing process, as well as the description of the ideal parameters to be checked when monitoring patients.

Caring for Children with Non-Accidental Head Injuries: A Case for a Child-Centered Approach.

Child abuse remains a significant issue. Non-accidental head injury (NAHI) is a major cause of mortality in young children with survivors often having to live a life with severe developmental and neurological dysfunction. The aim of this hermeneutic phenomenological research study was to examine the lived experiences of nurses who care for children and their families admitted to hospital with a non-accidental head injury. Semi-structured interviews were conducted with six nurses who had at least five years' experience of nursing children with NAHI. Following the interpretive approach described by van Manen data was analyzed and two essential themes identified. Firstly, nursing children with NAHI is different from the care of children admitted with a similar neurological injury related to accidental injuries or medical conditions. Secondly, when nursing these children nurses adopt protective qualities, conceptualized in this study as a shield of protection. The findings of this study support the findings of other studies in regard to the emotional labor required of nurses caring for children who have been subject to child abuse and the importance for nurses of maintaining a professional demeanor. The study highlighted the tensions of sustaining a family-centered care approach when caring for a child with NAHI. It is argued that greater acknowledgment and emotional support for nurses is needed and that a child-centered approach offers a more compatible model of care than Family-Centered Care in the acute phase of caring for children with a NAHI.

Accidente de tráfico: análisis de los casos de traumatismo cranoencefálico / Acidente de trânsito: análise dos casos de traumatismo cranioencefálico / Traffic accident: a review of cases of head trauma

Objetivo: Caracterizar a los pacientes víctimas de accidentes de tráfico internados en un hospital general de la ciudad de Natal y el accidente de tráfico sufrido por ellos. Métodos: Estudio exploratorio, descriptivo, transversal, retrospectivo, con abordaje cuantitativo, realizado con 90 víctimas de accidentes de tráfico, en el periodo de julio a noviembre de 2015, que tuvieron Traumatismo Craneoencefálico. Resultados: El 28,3% de las víctimas estudiadas pertenecían al sexo masculino, el 28,9% en el grupo de edad de 20-29 años, el 43,3% de los accidentes fueron en domingo, el vehículo más involucrado fue moto (83,3%), el 74,4% eran conductores de moto, el 26,7% hacía uso de casco y el 65,6% había bebido alcohol. La caída de moto representó el 50% de los accidentes. Se destacó el Traumatismo Craneoencefálico leve. Conclusión: El perfil de las víctimas de accidentes de tráfico con traumatismo craneoencefálico se caracteriza por individuos varones y jóvenes. El accidente presenta predominio el fin de semana, teniendo la moto como su mayor responsable y la ingestión de alcohol contribuye al evento

Objetivo: Caracterizar vítimas de acidente de trânsito internados em um hospital geral da cidade do Natal e o acidente de trânsito sofrido por eles. Métodos: Trata-se de uma pesquisa exploratória, transversal, com abordagem quantitativa, de caráter descritivo, realizada com 90 vítimas de acidente de trânsito, de julho a novembro de 2015, que tiveram Traumatismo Cranioencefálico. Resultados: Foram encontrados 90% das vítimas estudadas pertenciam ao sexo masculino, 28,9% na faixa etária de 20-29 anos, 43,3% dos acidentes foram no domingo, o veículo mais envolvido foi moto (83,3%), entre as vítimas 74,4% eram condutores de moto, 26,7% fazia uso de capacete e 65,6% havia feito uso de bebida alcoólica. A queda de moto representou 50% dos acidentes. Destacou-se o Traumatismo Cranioencefálico leve.Conclusão: O perfil das vítimas de acidentes de trânsito com traumatismo cranioencefálico caracteriza-se por indivíduos do sexo masculino e jovens. Já o acidente apresenta predomínio no final de semana, tendo a moto como o seu maior responsável e a ingestão de álcool contribuído para o evento

Objective: The objective of this study was to characterize the victims of traffic accidents hospitalized in a general hospital in the city of Natal and the traffic accident suffered by them. Methods: This is an exploratory, cross-sectional, quantitative, descriptive study conducted with 90 victims of traffic accidents, from July to November 2015, who had Cranioencephalic Trauma. Results: 90% of the victims studied were male, 28.9% were between 20-29 years of age, 43.3% of the accidents were on Sunday, the motorcycle was the most involved vehicle (83.3%). Victims were 74.4% motorcycle drivers, 26.7% were wearing helmets and 65.6% had drunk alcoholic beverages. The motorcycle crashes represented 48.9% of the accidents. Mild Cranioencephalic Trauma was highlighted. Conclusion: The profile of the victims of traffic accidents with traumatic brain injury is characterized by males and young people. Already the accident presents predominance at the end of the week, having the bike as its main responsible and the alcohol intake contributed to the event

The Effect of Telenursing on Referral Rates of Patients With Head Trauma and Their Family's Satisfaction After Discharge.

We aimed to assess the effect of telenursing on referral rates of patients with head trauma and their family's satisfaction after discharge. Seventy-two patients with head trauma were randomly allocated to equal intervention and control groups. The caregivers in both groups were provided with 1-hr face-to-face training on patients' home care and educational booklets, 2 days before discharge. The cell phone numbers of the telenurse was given to the caregivers of the intervention group. Then, the patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks and the patient status checklists were completed. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data were analyzed using SPSS software, version 19. Ultimately, 33 patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years were studied in the intervention group (p = .098). The 2 groups differed significantly with respect to referral rates; 39.4% of the participants in the control group referred to physicians whereas only 25.7% of the patients in the intervention group needed to refer to physicians (p = .017). Also, the mean times of referring to a physician differed significantly in both groups. In general, 53.8% of the caregivers were satisfied with the telenursing program. Follow-up programs using telephone calls were effective and would lead to higher caregiver satisfaction.

Application of the Canadian Computed Tomography Head Rule to Patients With Minimal Head Injury.

STUDY OBJECTIVE: Two clinical decision rules, the Canadian CT Head Rule and the New Orleans Criteria, set the standard to guide clinicians in determining which patients with minor head trauma need computed tomography (CT) imaging. Both rules were derived with patients with minor head injury who had had a loss of consciousness or witnessed disorientation. No evidence exists for evaluating patients and need for CT imaging with minimal head injury; that is, patients who had a head injury but no loss of consciousness or disorientation and therefore would have been excluded from the Canadian CT Head Rule and New Orleans Criteria trials. We evaluate the Canadian CT Head Rule in patients with head injury without loss of consciousness or witnessed disorientation (minimal head injury). METHODS: We studied a prospective convenience sample of patients with minimal head injury who received head CTs as part of their evaluations in the emergency department (ED). Participants were enrolled after head CT was ordered, but before the physician received the imaging results. Physicians were surveyed on their clinical reasoning for ordering imaging in this low-risk cohort of patients. Physicians surveyed consisted of ED attending physicians and senior-level emergency medicine residents. Final patient disposition was recorded when it became available. Patients with positive CT findings had their medical records reviewed for specific disposition, admission length of stay, ICU stay, and any operative or procedural interventions. RESULTS: Two hundred forty patients with minimal head injury were enrolled. Five patients (2.1%) had head CTs that were positive for intracranial hemorrhage. All instances of intracranial hemorrhage occurred in patients who were at high or moderate risk by the Canadian CT Head Rule (2 high risk [age], 3 moderate risk [mechanism]). No patient with intracranial hemorrhage went to the ICU or underwent any intervention; the average hospital length of stay was 1.25 days. The Canadian CT Head Rule was 100% sensitive (95% confidence interval 40% to 100%) and 29% specific (95% confidence interval 23% to 35%) for the presence of intracranial hemorrhage. Physicians listed their own reassurance (24.6%), patient reassurance (24.2%), patient expectation (14.6%), and reduction of legal liability (11.7%) as the rationale for ordering head CT in patients with minimal head injury. Shared decisionmaking was used in 51% of cases. CONCLUSION: Risk of intracranial hemorrhage in patients with minimal head injury was very low, and even in patients found to have an intracranial hemorrhage, none had any serious adverse outcome (eg, death, intubation, prolonged hospitalization, surgical procedure). The Canadian CT Head Rule was 100% sensitive in this small cohort of patients with minimal head injury. Among our study cohort, which specifically included only patients who had CT scanning, applying the Canadian CT Head Rule may have reduced the need for CT, potentially saving costs and resources. However, because many patients with minimal head injury who present to the ED may not have CTs, it is unclear what effect the broad application of this rule would have on overall CT use. Providers' rationale for obtaining CT was multifactorial. These represent barriers that may need to be overcome before physicians are comfortable changing CT ordering patterns in this group of head injury patients.

Recognition and nursing management of abusive head trauma in children.

Abusive head trauma (AHT) describes an injury to the head caused by a deliberate impact or shaking by a parent or carer. It can cause significant morbidity and mortality in infants, and is most commonly seen in those aged under 2 years. The initial presentation of AHT can include vague symptoms and the correct diagnosis may be missed by health professionals. Subdural haematoma, brain oedema and retinal haemorrhages are well-known features associated with AHT. However, other conditions such as birth trauma, accidental falls in infants and bleeding disorders can all mimic AHT, thus making its recognition difficult. Suspicion of AHT should lead to initiation of safeguarding procedures alongside organising neurological imaging to identify skull fracture and/or intracranial lesions. This article highlights different aspects of the clinical presentation of AHT and its management. Safeguarding and recognising child abuse is vital and requires every member of the multidisciplinary team to remain vigilant. An illustrative case study is included to highlight some of the challenges that health professionals working in different clinical set-ups are likely to come across while managing an infant with AHT.

Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses.

BACKGROUND: Early detection of pupillary changes in patients with head injuries can alert the care team to increasing intracranial pressure. Previous research has shown inconsistencies in pupil measurement that are most likely due to the subjective nature of measuring pupils without the assistance of technology. OBJECTIVES: To evaluate nurses' abilities to assess pupil diameter accurately and detect unequal pupils. METHODS: In a 3-part study, the accuracy of critical care and neurosurgical nurses' assessments of pupils was determined. The study included assessment of drawings of eyes with an iris and pupil, examination of photographs of human eyes, and bedside examination of patients with a head injury. RESULTS: Subjective assessments of pupil diameter and symmetry were not accurate. Across all phases of the study, pupil diameters were underestimated and the rate of error increased as pupil size increased. Nurses also failed to detect anisocoria and misidentified pupil reactivity. In addition, nearly all nurses relied on subjective estimation, even when tools were available. CONCLUSIONS: Critical care and neurosurgical nurses underestimated pupil size, were unable to detect anisocoria, and incorrectly assessed pupil reactivity. Standardized use of pupil assessment tools such as a pupillometer is necessary to increase accuracy and consistency in pupil measurement and to potentially contribute to earlier detection of subtle changes in pupils. If pupillary changes are identified early, diagnostic and treatment intervention can be delivered in a more timely and effective manner.

Caregivers' voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood.

Head injury is a leading cause of mortality and acquired neurological impairment in children. Head-injured children may have neurobehavioural deficits that persist for years following injury. Head injury can result in significant and persistent caregiver burden, including mental health issues, family stress and disorganisation, and unmet social and healthcare service needs. Few studies have examined the healthcare and social service needs of children and their families following head injury sustained at an early age. This qualitative study aims to describe the experiences of caregivers of children who sustained a serious head injury (particularly non-accidental head injury) before the age of 2 years. Caregivers were interviewed up to 15 years following the initial injury. Semi-structured interviews with 21 caregivers of 15 children (aged 3-15 years at the time of interview) were completed. Thematic analysis of interview data generated three key themes: impact, support and information. The study's findings reveal the broad impact of serious childhood head injury on caregivers, specifically the significant distress and burden brought about through lack of information, challenges in accessing support and inconsistent care. Recommendations for developing a quality 'model of care' and improving ease of access to supports for caregivers are provided.

Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection: A Multi-Center Study of Clinical Decision Support for Children with Head Trauma.

BACKGROUND: Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts. OBJECTIVES: To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR. METHODS: As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity. RESULTS: Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75-89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites. CONCLUSIONS: CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.

La relación entre la percepción del cuidador sobre los síntomas derivados del daño cerebral en personas con traumatismos craneoencefálicos y su propia Salud Mental / Relationship between caregivers’ perception of Traumatic brain injury symptoms and caregiver’s mental health

Objetivo: Determinar si existe una relación entre la percepción que tiene el cuidador de los síntomas que presentan los pacientes con traumatismos craneoencefálicos (TCE) y su salud mental. Participantes: Se entrevistó a 50 cuidadores de individuos con TCE de la ciudad de Barranquilla, Colombia, a quienes se les aplicó la escala de satisfacción con la vida, la versión en español del Patient Health Questionary-9, la escala de sobrecarga de Zarit, la escala de autoestima de Rosenberg, el inventario de ansiedad estado-rasgo y un cuestionario de 22 preguntas que evaluó la percepción de síntomas del individuo con TCE, compuesto por cuatro grupos de síntomas: cognitivos, neuroconductuales, físicos y sociales. Resultados: Los análisis de correlación canónica revelaron que a mayor número de síntomas que se perciben en el paciente, peor es la salud mental que tienen los cuidadores, específicamente se encontró que a mayor percepción de síntomas neuroconductuales en el paciente mayor sobrecarga, mayor depresión y menor autoestima en el cuidador. Conclusiones: Los resultados sugieren la necesidad de desarrollar e implementar programas de intervención psicoterapéutica, así como terapia de rehabilitación cognitiva, con el fin de reducir o eliminar los problemas neuroconductuales en personas con TCE en Colombia. De igual forma, es importante el diseño de intervenciones que trabajen de manera paralela con los cuidadores y familiares para orientarlos respecto al impacto que puede tener el TCE tanto en la vida del paciente, como en la familia, brindándoles, además, herramientas para manejar la aparición de problemas emocionales, como la depresión, la baja autoestima y la sobrecarga (AU)

Objective: To determine the system of connections between mental health and symptoms perception of caregivers of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. Participants: 50 caregivers of individuals with TBI completed the Satisfaction with Life Scale, PHQ-9 (depression), Zarit Burden Interview, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and a 22-question TBI symptoms perception inventory composed of four component areas: cognitive symptoms, neurobehavioral symptoms, physical symptoms and social symptoms. Results: A canonical correlation analysis revealed that the higher the caregivers’ symptoms perception, the worse their mental health was, with the effect reaching a large-sized effect. Furthermore, a pattern emerged linking caregivers’ higher perception of neurobehavioral symptoms to higher caregivers’ burden, depression, and lower self-esteem. Conclusions: These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to reduce neurobehavioral symptoms in people with TBI, interventions to improve self-steem, reduce depression symptoms, and burden in Colombian caregivers of individuals with TBI (AU)

'It's the hearing that is last to go': a case of traumatic head injury.

This article explores the literature related to acquired brain injury (ABI) and is followed by a case study of one patient with ABI, which reflects how the evidence, when implemented by a team of health professionals, can have a positive impact on recovery. Gregor is a middle-aged Polish man who suffered traumatic ABI when knocked down by a car. He spent a number of years in a specialist neurosurgical unit, then a rehabilitation unit, and for the past several years has been cared for in a care home. For most of this time he was in a coma. He began to come out of his coma and during his time in the care home received intensive physiotherapy and speech therapy. At the time of his brain injury Gregor could speak no English yet years later, when he began to regain consciousness, he was able to speak and understand English, a fact that might be attributed in part to 6 years of nurses talking to him in English as part of caring for him. Nurses are always told that hearing is the last of the senses to be lost when a person is unconscious or has a brain injury (Sisson, 1990). The case study presented in this article demonstrates the potential power of talking to a patient when providing care, even when that patient is in a coma, and the impact this may have had on Gregor. It also demonstrates the importance of the need for evidence-based neuro-rehabilitation, including multi-professional working by a team of specialist physiotherapists, nurses, speech therapists, continence specialist nurse and nutritionist.

Narratives of family transition during the first year post-head injury: perspectives of the non-injured members.

AIM: To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury. BACKGROUND: A head injury is a potentially devastating injury. The family responds to this injury by supporting the individual and their recovery. While the perspective of individual family members has been well documented, there is growing interest in how the family as a whole makes sense of their experiences and how these experiences change over time. DESIGN: Longitudinal narrative case study using unstructured in-depth interviews. METHODS: Data were collected during an 18-month period (August 2009-December 2010). Nine non-injured family members from three families were recruited from an acute neurosurgical ward and individual narrative interviews were held at one, three and 12 months postinjury where participants were asked to talk about their experience of head injury. Analysis was completed on three levels: the individual; the family and between family cases with the aim of identifying a range of interwoven narrative threads. FINDINGS: Five interwoven narratives were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the year post-head injury was a turbulent time for families, who were active agents in the process of change. CONCLUSION: This study has shown the importance of listening to people's stories and understanding their journeys irrespective of the injured person's outcome. Change postinjury is not limited to the injured person: family members need help to understand that they too are changing as a result of their experiences.

Sports-related head injuries in students: parents' knowledge, attitudes, and perceptions.

The short- and long-term neurologic impairment of children sustaining sports-related head injuries has recently entered the forefront of medical literature, resulting in new guidelines on concussion management being provided to clinicians, coaches, and trainers. Yet, most parents have not been formally educated on head injuries. The purpose of this article is to share the findings of a study conducted with 235 parents that identified their knowledge, attitudes, and perceptions of sports-related head injuries in school-age students. The study found that 51% of respondents were unaware that head trauma was more serious in children, 80% were uninformed as to whether the school district had a policy on sports-related head injuries, 44% did not know if there were medical guidelines for return to play, and 35% did not know that repeated head trauma could cause dementia. Results of this research implore school nurses to improve patient and parental education when they care for and monitor students with head injuries.

Escalas para avaliação donível de consciência emtrauma cranioencefálico e suarelevância para a prática deenfermagem em neurocirurgia / Scales of level of awareness traumatic brain injury and their relevance to practice nursing in neurosurgery Deborah

A eficácia da equipe da emergência reduziu a taxa de morbimortalidade de pacientes com traumatismocranioencefálico, todavia estabelecer intervenções padronizadas exige conhecimento e preparoespecí!co. O objetivo do trabalho foi realizar uma revisão da literatura sobre escalas para avaliaçãodo nível de consciência em pacientes com trauma cranioencefálico, chamando a atenção para a suaimportância na prática de enfermagem em neurocirurgia. Foi realizada busca de artigos cientí!cos nasbases dados Elservier, Lilacs, PubMed Medline, SciELO, ScienceDirect e Scirus, com as palavras-chave“escalas de coma” e “traumatismos craniocerebrais”, além de ser feita pesquisa adicional em bancos dedados de dissertações, teses e livros texto. A literatura consultada revela que, apesar de vários estudosdestacarem a importância do tema, a avaliação neurológica com a utilização de outras escalas não éprática rotineira nas unidades de trauma...

The effectiveness of the emergency team reduced the mortality rate of patients with traumatic braininjury; however, provide tailored interventions require speci!c knowledge and skills. This article presentsa literature review about scales of level of consciousness in patients with brain injury, calling attentionto its importance in neurosurgery nursing practice. We conducted a search of scienti!c articles throughthe databases Elservier, Lilacs, PubMed Medline, SciELO, ScienceDirect, Scirus using the keywords“coma scales”, “craniocerebral trauma”, and additional research on databases of theses, dissertationsand textbooks. The literature shows that, although several studies detach the importance of the topic,neurological evaluation, using others scales are not a routine practice in trauma units...