Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

Table 1 Key points of severe craniocerebral injury critical signal observation and monitoring

Complication	Observation points
Abnormal increase of intracranial pressure	Headache, malignant vomiting, drowsiness, yawning, etc.
Cerebral hernia	The size of the bilateral pupil was different, and the light reflex disappeared.
Respiratory dysfunction or failure	Oxygen saturation was lower than 94%, intermittent sigh breathing or mandibular breathing.
Airway obstruction	Frequent vomiting or hiccup, disease after a full meal, snoring like breathing.
Massive cerebral infarction or massive cerebral hemorrhage	Immediately after the onset of the disease or progressive disturbance of consciousness, eye gaze, GCS score below 7, atrial fibrillation.

GCS: Glasgow Coma Scale.

Table 2 Patient characteristics

	Study group	Control group	t/χ2	P value
Sex (male/female)	48/17	42/19	0.37	0.39
Age1 (yr)	38. 59 ± 6. 21 (26-61)	39.80 ± 6.47 (24-59)	1.24	0.23
NIHSS2	26.42 ± 4.15	25.74 ± 4.04	0.34	0.89
GSC2	6.15 ± 2.46	6.27 ± 2.24	0.33	0.56
Cause of injury
Traffic accident	30	27	0.93	0.81
Fell and hurt oneself	24	20
Injury	7	10
Other	4	4

¹mean ± SD (Range).

²mean ± SD.

NIHSS: National Institutes of Health Stroke Scale/Score; GCS: Glasgow Coma Scale.

Table 3 Comparison of the National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale between the two groups

Group	n	NIHSS		GCS
		Before	After	Before	After
Study group	65	26.42 ± 4.15	10.23 ± 3.26a	6.15 ± 2.46	12.48 ± 2.38a
Control group	61	25.74 ± 4.04	14.79 ± 3.14a	6.27 ± 2.24	9.32 ± 2.01a
t		0.34	9.38	0.33	6.92
P value		0.89	0.00	0.56	0.01

^aCompared with the group before emergency treatment, the difference was statistically significant. NIHSS: National Institutes of Health Stroke Scale/Score; GCS: Glasgow Coma Scale.

Table 4 Comparison of rescue time between the two groups

Group	Check the return time	Consultation arrival time	Retention time in the emergency room	Ward handover time
Study group	22.45 ± 6.27	20.56 ± 19.12	45.12 ± 10.21	4.98 ± 2.15
Control group	24.07 ± 6.12	48.31 ± 10.23	70.12 ± 11.12	5.02 ± 1.42
t	2.38	9.52	10.09	1.07
P value	0.07	0.00	0.00	0.18

Table 5 Comparison of Glasgow Coma Scale scores and Barthel Index between the two groups after 3 mo of rehabilitation management

Group	n	GCS	Barthel Index
Study group	65	14.56 ± 3.75	58.14 ± 12.14
Control group	61	11.24 ± 2.34	36.14 ± 13.01
t		7.21	10.24
P value		0.01	0.00

GCS: Glasgow Coma Scale.

Table 6 Comparison of complications within 3 mo of rehabilitation management between the two groups

Group	n	Central hyperthermia	Joint stiffness	Limb swelling	Muscle atrophy	Postural hypotension	Rate
Study group	65	2	2	1	3	2	15.38%
Control group	61	5	6	3	4	2	32.79%
χ2							7.31
P value							0.01

Table 7 Comparison of patients with posterior muscle strength ≥ grade III

Group	n	Muscle strength ≥ grade III	Rate
Study group	65	58	89.23%
Control group	61	31	50.82%
χ2			6.17
P value			0.03

Table 8 Comparison of satisfaction between the two groups

Group	n	Nursing operation	Nursing service attitude	Nursing effect
Study group	65	8.34 ± 2.31	6.97 ± 1.38	9.45 ± 1.01
Control group	61	4.79 ± 1.32	4.53 ± 1.67	5.67 ± 2.15
χ2		12.78	7.54	13.11
P value		0	0.01	0