UNIVERSITY OF SANTO TOMAS – COLLEGE OF NURSING

Espana Boulevard, Sampaloc, Manila, Philippines 1015

Tel. No. 406-1611 loc.8241 | Telefax: 731-5738 | Website: www.ust.edu.ph

Name: SALAZAR, Nica Sharmaine C. RLE: 8.4

Yr.&Sec.: 4NUR8 Clinical Instructor: Ma’am Ros

RESEARCH BIBLIOGRAPHY LEVEL IV

Title of the article:
Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia
APA Format:
Gupta, S., Iv, V., Sam, N., Vuthy, D., Klaric, K., Shrime, M. G., & Park, K. B. (2017). Impact of
Helmet Use on Severity of Epidural Hematomas in Cambodia. World Neurosurgery,100, 267-
270. doi:10.1016/j.wneu.2016.12.104

Guide Questions:

1. Using the PICO format, formulate your questions:

a. What is the population of interest?
 The population of interest in the study are the patients who have Epidural
Hematoma.
b. What is the intervention implemented or the interest?
 The Intervention that was implemented in the study is the use or the wearing of
Protective Helmet when riding/driving motorcycles to reduce the severity of the
hematoma and to prevent serious damages.
c. What is the comparison? Or the current applicable practice or status?
 The current practice coincides with the intervention used in the study. The study,
furthermore, encourages the riders to wear Protective helmet to prevent Traumatic
Brain Injury and Epidural Hematoma that may eventually lead to serious
complications and even death.
d. What is the outcome of interest?
 The Outcome of interest of this study is convincing the readers that wearing
Protective Helmet helps reduce the severity of epidural hematoma. Patients with
Traumatic Brain Injury after motorcycle road traffic accidents, in which they wore
helmets, present to the hospital with less clinically severe Epidural hematoma and
are less likely to require neurosurgical intervention. This is the first study to analyze
the clinically protective effect of helmets on Epidural Hematoma in a Low-income
country and suggests that helmets may be an effective way to reduce Traumatic
Brain Injury burden.

2. Discuss your process of evidence research

a. Identify key words used
  EDH, epidural hematoma, TBI, helmets, RTAs
b. Identify data bases used
 Science direct
 Elsevier
c. Identify at least 5 potential articles relevant to your problem
Cripton, P. A., Dressler, D. M., Stuart, C. A., Dennison, C. R., & Richards, D. (2014).
Bicycle helmets are highly effective at preventing head injury during head impact: Head-
form accelerations and injury criteria for helmeted and unhelmeted impacts. Accident
Analysis & Prevention,70, 1-7. doi:10.1016/j.aap.2014.02.016 (LEVEL IV)
Flaherty, B. F., Moore, H. E., Riva-Cambrin, J., & Bratton, S. L. (2017). Pediatric patients
with traumatic epidural hematoma at low risk for deterioration and need for surgical
treatment. Journal of Pediatric Surgery,52(2), 334-339.
doi:10.1016/j.jpedsurg.2016.09.005 (LEVEL IV)
Gupta, S., Iv, V., Sam, N., Vuthy, D., Klaric, K., Shrime, M. G., & Park, K. B. (2017).
Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia. World
Neurosurgery,100, 267-270. doi:10.1016/j.wneu.2016.12.104 (LEVEL IV)
Sethi, M., Heidenberg, J., Wall, S. P., Ayoung-Chee, P., Slaughter, D., Levine, D. A., . . .
Frangos, S. G. (2015). Bicycle helmets are highly protective against traumatic brain
injury within a dense urban setting. Injury,46(12), 2483-2490.
doi:10.1016/j.injury.2015.07.030 (LEVEL IV)
Zhang, Y., Li, Q., Zhao, R., Yang, Z., Li, Y., Min, W., . . . Liu, J. (2018). Novel Minimally
Invasive Treatment Strategy for Acute Traumatic Epidural Hematoma: Endovascular
Embolization Combined with Drainage Surgery and Use of Urokinase. World
Neurosurgery,110, 206-209. doi:10.1016/j.wneu.2017.11.047 (LEVEL IV)

d. Choose one article to appraise

Gupta, S., Iv, V., Sam, N., Vuthy, D., Klaric, K., Shrime, M. G., & Park, K. B. (2017).
Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia. World
Neurosurgery,100, 267-270. doi:10.1016/j.wneu.2016.12.104

This study is the first one to analyze the clinical value of wearing helmets. It was
mentioned in the study that Not wearing a helmet is also associated with a statistically
significant increase in the requirement of craniotomy or craniectomy on multivariate
logistic regression, therefore patients who had not worn helmets during their accidents
were exposed to surgical risks and complications. The study concludes that helmets
usage is protective in reducing the severity of presentation and need for neurosurgical is
protective in reducing the severity of presentation and need for neurosurgical. data
further show that increasing helmet usage may mitigate these costs by having a
protective effect for patients presenting with Traumatic Brain Injuries with Epidural
Hematoma. The impact of helmet use on lowering the prevalence severity of Traumatic
Brain Injury-related injuries is consistently seen across various settings

e. Assess the available evidence for its appropriateness and applicability for our practice
 The research questions, design, instrument, and interventions used were all
appropriate. The only issue is the data collection, due to lack of funds, the researchers
failed to continue and do a follow-up a data collection to determine the long-term effects
of helmets usage in patients who had epidural hematoma. But in general, the study was
interesting and factual. In the Philippine setting, motorists are indeed highly encouraged
to wear protective helmet to prevent road accidents, in fact, violators are being
apprehended. By the time the RA 10054 was passed, a year after, the figures of death
from motorcycle accidents drastically dropped. In this cohort, patients with Traumatic
Brain Injury after motorcycle RTAs in which they wore helmets present to the hospital
with less clinically severe.
Epidural Hematoma and are less likely to require neurosurgical intervention.
3. Give your general comment on the study identified

The study was very timely. It is layman-friendly, the study caters both the health
care providers and at the same time the motorists. The study was very factual and
informative. Given the current setting, it is indeed helpful to wear protective helmets
when driving especially in our country where one cannot expect the weather to be
gloomy and leave the road wet and accident-prone and where commuters would prefer
to use a motorcycle instead of SUVs and PUJs because of the endless traffic. It is
convenient to use motorcycles but with the appropriate gears. This study would benefit
and help enforce the RA 10054 law, that requires motorists to use protective helmets.
the protective impact of simple bicycle helmets in the event of a crash remains
significant.

4. Give your recommendation for evidence based practice

If I were to re-conduct this study, I would continue it since the researchers failed
to do a follow-up. I would collect further data to determine the long-term impact of helmet
usage on EDH.