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  • Questionnaire Head Injury Clinical Assessment

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    tameem
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    This document is a questionnaire for collecting personal and medical information from a patient admitted with head trauma. It collects details on demographics, mechanism of injury, clinical presentation including symptoms, signs, investigations and their results, need for surgical intervention, operative findings if surgery was performed, and outcome based on the Glasgow Outcome Scale. The questionnaire is used to comprehensively document all relevant information needed for properly diagnosing and managing the patient's condition.

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    Questionnaire 27-03-2014

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    This document is a questionnaire for collecting personal and medical information from a patient admitted with head trauma. It collects details on demographics, mechanism of injury, clinical presentation including symptoms, signs, investigations and their results, need for surgical intervention, operative findings if surgery was performed, and outcome based on the Glasgow Outcome Scale. The questionnaire is used to comprehensively document all relevant information needed for properly diagnosing and managing the patient's condition.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views2 pages

    Questionnaire Head Injury Clinical Assessment

    Uploaded by

    tameem
    This document is a questionnaire for collecting personal and medical information from a patient admitted with head trauma. It collects details on demographics, mechanism of injury, clinical presentation including symptoms, signs, investigations and their results, need for surgical intervention, operative findings if surgery was performed, and outcome based on the Glasgow Outcome Scale. The questionnaire is used to comprehensively document all relevant information needed for properly diagnosing and managing the patient's condition.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    Questionnaire

    Personal Data: .
    Age: ...........................................................
    Sex: Male □ Female □
    Marital Status: Single □ Married □
    Occupation: ...........................................................
    Address: .........................................................................................
    Phone No.: ...........................................................
    Date of admission: ............................., Date of Discharge: ...............................
    Medical Record No.: ...........................................................
    Mechanism of Injury: .
    ........................................................................................................................
    ........................................................................................................................
    Clinical pictures: .
    Symptoms: .
    Headache: Yes □ No □
    Vomiting: Yes □ No □
    Seizures: Yes □ No □
    Focal Neurological Signs: Yes □ No □
    Signs: .
    Otorrhea: Yes □ No □
    Rhinorrhea: Yes □ No □
    Skull fracture: Yes □ No □
    Anisocoria: Yes □ No □
    Bradycardia: Yes □ No □
    Hypertension: Yes □ No □
    Level of consciousness according to Glasgow Coma Scale (GCS): □
    ≥ 13 □ 9 -12 □ ≤8 □
    Investigations: □
    Skull X-ray: Yes □ No □
    Coagulopathy: Yes □ No □
    CT scan: ..
    < 2 hrs □ 2 - 6 hrs □ > 6 hrs □
    Hematoma site: ..
    Frontal Lobe: Yes □ No □
    Temporal Lobe: Yes □ No □
    Parietal Lobe: Yes □ No □
    Occipital Lobe: Yes □ No □
    Cerebellum: Yes □ No □
    Hematoma Density: ..
    Hypo-dense: Yes □ No □
    Hyper-dense: Yes □ No □
    Mixed: Yes □ No □
    Hematoma volume: ..
    Transverse diameter = ....................................................mm
    Antero-posterior diameter = ....................................................mm
    Cranio-caudal diameter = ....................................................mm
    Management: .
    Surgical intervention: □
    ≤ 6 hrs □ > 6 hrs □ None □
    Operative findings: □
    Hematoma Pattern: .
    Clot Yes □ No □
    Partial liquefied hematoma Yes □ No □
    Liquefied hematoma Yes □ No □
    Active bleeding Yes □ No □
    Glasgow Outcome
    Scale:
    Good recovery □
    Moderate disability (able to live independently) □
    Severe disability (unable to live independently) □
    Persistent vegetative state (unresponsive) □
    Dead □

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