The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Review Comparative Study
Grading scales used in the management of aneurysmal subarachnoid hemorrhage: a critical review.
The use of grading scales to predict clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is commonplace. In recent times management of aSAH patients has developed such that surgical intervention is taking place earlier in the course of the illness. Given the complex and multifactoral clinical picture of these patients, there is an increased impetus to examine and reevaluate the relative merits and predictive characteristics of grading scales. ⋯ Reports on newly developed instruments often lacked the replication data necessary to effectively compare measures currently in use. The timing of measurements and the use of serial measures emerged as important factors in the prediction of clinical outcomes. Assessments taken close to the time of surgical intervention were found to have superior predictive abilities.
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Clearing the cervical spine in adult trauma patients must be done cautiously and methodically. Practitioners must be able to recognize abnormalities not only in the patient's neurological examination but also on the radiographic views obtained. A missed cervical spine injury can be a significant and catastrophic error. Nurse practitioners in the emergency department, as well as those working on an inpatient trauma service, should be confident in their ability to manage the cervical spine in the adult trauma patient population.