Silvia Cristina Fürbringer e Silva

Galveston Orientation and Amnesia Test: applicability and relation with the Glasgow Coma Scale

Restricciones en la aplicacion del Galveston Orientation and Amnesia Test y los cuestionamientos sobre la relacion entre conciencia y amnesia post-traumatica motivaron este estudio que visa identificar, a traves de la puntuacion de la Escala de Coma de Glasgow, el periodo mas adecuado para la aplicacion de la prueba de amnesia, y observar la relacion entre los resultados de esos dos indicadores. El estudio prospectivo y longitudinal fue realizado en un centro de referencia para traumas en Sao Paulo - Brasil. El numero fue de 73 victimas de trauma craneoencefalico contuso, internadas en esta institucion en el periodo de 03/01 a 03/05/2001. Con relacion a la aplicabilidad, la prueba puede ser aplicada en los pacientes con la Escala de Coma de Glasgow > 12, pero el termino de la amnesia post-traumatica fue observado en los pacientes con puntuacion > 14 en la escala. Correlacion significativa (rs = 0,65) fue observada entre esas medidas, aunque diferentes formas de relacion entre el termino de la amnesia y alteracion de conciencia fueron observadas.Restrictions in the application of the Galveston Orientation and Amnesia Test and questionings about the relationship between conscience and post-traumatic amnesia motivated this study, which aims to identify, through the Glasgow Coma Scale scores, when to initiate the application of this amnesia test, as well to verify the relationship between the results of these two indicators. The longitudinal prospective study was carried at a referral center for trauma care in Sao Paulo - Brazil. The sample consisted of 73 victims of blunt traumatic brain injury, admitted at this institution between January 03rd and May 03rd 2001. Regarding the applicability, the test could be applied in patients with a Glasgow Coma Scale score > 12; however, the end of post traumatic amnesia was verified in patients who scored > 14 on the scale. A significant relationship (rs = 0.65) was verified between these measures, although different kinds of relationship between the end of the amnesia and changes in consciousness were observed.

Galveston Orientation and Amnesia Test: tradução e validação

OBJETIVO: Traduzir e validar o Galveston Orientation and Amnesia Test para uso em nosso meio. METODOS: Esse teste foi traduzido para o portugues e retro-traduzido para o ingles por diferentes especialistas na lingua e por fim, feita a avaliacao da equivalencia entre o instrumento original e a versao retro-traduzida. Sua aplicacao em 73 vitimas de trauma crânio-encefalico contuso e a indicacao da gravidade dessa lesao, estabelecida pela Escala de Coma de Glasgow, permitiram verificar as propriedades de medida do instrumento. RESULTADOS: A confiabilidade verificada pelo Alfa de Cronbach resultou em 0,76. Houve indicacao de validade convergente e discriminante do instrumento quando os resultados de aplicacao do Galveston Orientation and Amnesia Test foram analisados perante a gravidade do trauma crânio-encefalico. CONCLUSAO: Os resultados observados dao suporte para a aplicacao do Galveston Orientation and Amnesia Test em nosso meio como indicador do termino da amnesia pos-traumatica.

Galveston Orientation Amnesia Test (GOAT)

Closed head injury (CHI) is frequently followed by post-traumatic amnesia (PTA) and is characterized by a transitory state of confusion and disorientation. The PTA duration has been used to quantify the CHI severity and to predict disorders in cognitive functions, as well as to foresee any alteration in the functional capacity of post-trauma victims. The Galveston Orientation Amnesia Test (GOAT) is the first systematized instrument created, and the most broadly applied, to assess PTA. This article presents the GOAT, the conceptual basis for the development of the instrument, and its adaptation and validation to the Brazilian culture. In addition, the article describes the application of the instrument and makes comments on the restrictions of its use. Brazilian research results showed evidences of the GOATs validity. They also point to the indicators of post-trauma conditions in which the GOAT must be applied, and highlight the difficulties in the application of the instrument.

O QUE LEMBRA O PACIENTE COM TCE SOBRE O PERÍODO DE HOSPITALIZAÇÃO

Traumatic brain injured (TBI) patients with different trauma severity were analyzed about their recollection concerning the period of hospitalization. The study was carried out in the Head Injury Outpatient Clinic at the Central Institute of the FMUSP Hospital including 45 conscious patients able to sustain an interview. Most patients were male, young adults with the major cause of trauma such as traffic accidents and falls. Most patients (86%) reported unconsciousness state of different time duration in their hospitalization period and were unable to remember anything related to that period. The predominant recollection reported by the patients who never had consciousness decreased after the trauma and that ones who had it but awoke during the hospitalization were: seeing, feeling, hearing, and reacting either to sounds and procedures.Trata-se da analise das lembrancas do periodo de internacao referidas pelos pacientes que sofreram TCE de diferentes gravidades. O estudo foi realizado no ambulatorio de Trauma de Crânio do Instituto Central do HC-FMUSP com amostra de 45 pacientes conscientes e capazes de manter entrevista. Predominaram pacientes do sexo masculino, adultos jovens, que tiveram como causas acidentes de trânsito e quedas. A maioria (86,0%) informou ter ficado desacordada em diferentes tempos de duracao e nada recordar deste periodo. Naqueles que sempre estiveram alertas ou que acordaram ainda internados as lembrancas relacionaram-se com ter visto, sentido, ouvido ou reagido a sons e procedimentos.Traumatic brain injured (TBI) patients with different trauma severity were analyzed about their recollection concerning the period of hospitalization. The study was carried out in the Head Injury Outpatient Clinic at the Central Institute of the FMUSP Hospital including 45 conscious patients able to sustain an interview. Most patients were male, young adults with the major cause of trauma such as traffic accidents and falls. Most patients (86%) reported uncosciouness state of different time duration in their hospitalization period and were unable to remember anything related to that period. The predominant recollection reported by the patients who never had consciousness decreased after the trauma and that ones who had it but awoke during the hospitalization were: seeing, feeling, hearing, and reacting either to sounds and procedures.

Escala de Coma de Glasgow en las primeras 72 horas postrauma encefalocraneano y mortalidad hospitalaria

El estudio tiene como objetivos verificar y comparar el desempeno de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos despues de la atencion inicial intra-hospitalaria, ademas de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de prediccion de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 victimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeno de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las areas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la practica clinica para estimar el pronostico de las victimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scales predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instruments moderate discriminatory power.

Amnésia pós-traumática e qualidade de vida pós-trauma

The present study aims to compare quality of life of victims with long and short term post-traumatic amnesia and to analyze the relation between quality of life and length of amnesia, including or not the comatose period. This prospective cohort study, gathered data during the hospital stay and 3 and 6 months post- trauma. Blunt traumatic brain injury patients, over 14 years old, with no prior diagnosis of dementia or brain injury, admitted to a trauma center 12 hours post-trauma were included. The results were unfavorable among patients with long term amnesia. Correlation between length of post-traumatic amnesia and quality of life domains were more expressive when excluded comatose period, indicating that it must not be computed in the length of post-traumatic amnesia.Este estudo compara a qualidade de vida das vitimas que apresentaram amnesia pos-traumatica de longa duracao com as demais e analisa a relacao entre qualidade de vida e duracao da amnesia pos-traumatica, computando ou nao o periodo de coma. Estudo de coorte prospectivo, com coleta de dados durante a internacao hospitalar e avaliacao da qualidade de vida no periodo de estabilidade da recuperacao pos-traumatica. Participaram desta investigacao vitimas de trauma crânio-encefalico contuso, maiores de 14 anos, sem antecedentes de demencia ou trauma crânio-encefalico, internadas em hospital de referencia para atendimento de trauma nas primeiras 12 horas pos-evento. Os resultados referentes a qualidade de vida foram mais desfavoraveis em tres dominios do grupo com amnesia de longa duracao. Correlacoes entre duracao da amnesia e dominios de qualidade de vida foram mais expressivas quando excluido o periodo de coma, indicando que este tempo nao deve ser computado na duracao da amnesia pos-traumatica.

Amnesia post-traumática y calidad de vida post-trauma

The present study aims to compare quality of life of victims with long and short term post-traumatic amnesia and to analyze the relation between quality of life and length of amnesia, including or not the comatose period. This prospective cohort study, gathered data during the hospital stay and 3 and 6 months post- trauma. Blunt traumatic brain injury patients, over 14 years old, with no prior diagnosis of dementia or brain injury, admitted to a trauma center 12 hours post-trauma were included. The results were unfavorable among patients with long term amnesia. Correlation between length of post-traumatic amnesia and quality of life domains were more expressive when excluded comatose period, indicating that it must not be computed in the length of post-traumatic amnesia.Este estudo compara a qualidade de vida das vitimas que apresentaram amnesia pos-traumatica de longa duracao com as demais e analisa a relacao entre qualidade de vida e duracao da amnesia pos-traumatica, computando ou nao o periodo de coma. Estudo de coorte prospectivo, com coleta de dados durante a internacao hospitalar e avaliacao da qualidade de vida no periodo de estabilidade da recuperacao pos-traumatica. Participaram desta investigacao vitimas de trauma crânio-encefalico contuso, maiores de 14 anos, sem antecedentes de demencia ou trauma crânio-encefalico, internadas em hospital de referencia para atendimento de trauma nas primeiras 12 horas pos-evento. Os resultados referentes a qualidade de vida foram mais desfavoraveis em tres dominios do grupo com amnesia de longa duracao. Correlacoes entre duracao da amnesia e dominios de qualidade de vida foram mais expressivas quando excluido o periodo de coma, indicando que este tempo nao deve ser computado na duracao da amnesia pos-traumatica.

Escala de Coma de Glasgow nas primeiras 72 horas após trauma cranioencefálico e mortalidade hospitalar

El estudio tiene como objetivos verificar y comparar el desempeno de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos despues de la atencion inicial intra-hospitalaria, ademas de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de prediccion de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 victimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeno de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las areas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la practica clinica para estimar el pronostico de las victimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scales predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instruments moderate discriminatory power.

Fatores associados à amnésia pós-traumática de longa duração

Objective: To identify factors related to post-traumatic amnesia of long duration. Method: A prospective, longitudinal study, with 187 victims of blunt head trauma, age >14 years, seen at a referral hospital for trauma. Independent variables included: age, sex, severity of head injury, location and type of injury, number of brain lesions, and use of medication with central nervous system activity or corticosteroids. Results: The logistic regression model adjusted by the variable area of injury (intra / extra-axial) showed: an initial Glasgow Coma Scale of 3 (OR = 2.80) and use of phenytoin (OR = 2.60), midazolam (OR = 2.83) or both drugs (OR = 3.83). Conclusion: The use of midazolam and phenytoin, and the severity of head injury, were identified as related factors for long-term amnesia.Objective: To identify factors related to post-traumatic amnesia of long duration. Method: A prospective, longitudinal study, with 187 victims of blunt head trauma, age >14 years, seen at a referral hospital for trauma. Independent variables included: age, sex, severity of head injury, location and type of injury, number of brain lesions, and use of medication with central nervous system activity or corticosteroids. Results: The logistic regression model adjusted by the variable area of injury (intra / extra-axial) showed: an initial Glasgow Coma Scale of 3 (OR = 2.80) and use of phenytoin (OR = 2.60), midazolam (OR = 2.83) or both drugs (OR = 3.83). Conclusion: The use of midazolam and phenytoin, and the severity of head injury, were identified as

Fatores asociados a la amnesia post-traumática de larga duración

Objective: To identify factors related to post-traumatic amnesia of long duration. Method: A prospective, longitudinal study, with 187 victims of blunt head trauma, age >14 years, seen at a referral hospital for trauma. Independent variables included: age, sex, severity of head injury, location and type of injury, number of brain lesions, and use of medication with central nervous system activity or corticosteroids. Results: The logistic regression model adjusted by the variable area of injury (intra / extra-axial) showed: an initial Glasgow Coma Scale of 3 (OR = 2.80) and use of phenytoin (OR = 2.60), midazolam (OR = 2.83) or both drugs (OR = 3.83). Conclusion: The use of midazolam and phenytoin, and the severity of head injury, were identified as related factors for long-term amnesia.Objective: To identify factors related to post-traumatic amnesia of long duration. Method: A prospective, longitudinal study, with 187 victims of blunt head trauma, age >14 years, seen at a referral hospital for trauma. Independent variables included: age, sex, severity of head injury, location and type of injury, number of brain lesions, and use of medication with central nervous system activity or corticosteroids. Results: The logistic regression model adjusted by the variable area of injury (intra / extra-axial) showed: an initial Glasgow Coma Scale of 3 (OR = 2.80) and use of phenytoin (OR = 2.60), midazolam (OR = 2.83) or both drugs (OR = 3.83). Conclusion: The use of midazolam and phenytoin, and the severity of head injury, were identified as