Neurological Assessment in the Acute Care Practice Environment of Northern Ontario Hospitals

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability in developed countries and in Ontario. Trauma is the primary cause of neurological injury contributing to disability and loss of productive years. Neurological assessment remains the cornerstone to identifying evolving injury and planning care. A comprehensive assessment including all components related to neurological function, such as Glasgow Coma Scale (GCS), pupillary size and light reactivity, limb strength and vital signs, is paramount if the nurse is to initiate prompt action by medical personnel meant to improve survival outcomes and minimize long term sequelae. Clinical surveillance is essential in the identification of physiological changes and is vital in deciding whether computerized tomography (CT) is necessary. This is especially important in regions where a return trip for diagnostic testing can extend the length of time in reaching a medical diagnosis and treatment. Recent studies have indicated gaps in the documentation of neurological assessment. Numerous studies have examined factors that influence patient outcomes following TBI, few have looked at the short term outcomes of immediate care for mild TBI and none could be found to suggest on-going clinical surveillance provided in the first six hours contributed to positive or negative outcomes.

Keywords

• traumatic brain injury
• head injury
• epidemiology
• emergency department
• clinical assessment
• nursing assessment
• adult
• glasgow coma scale
• vital signs
• documentation
• chart review
• northern and rural health
• ontario