Survival Rate Prediction of Head Injury Patients with Peripheral Oxygen Saturation

Good management of head injuries can improve patient survival. Examination of peripheral oxygen saturation (SpO2) is a procedure performed at the primary survey. This study aims to predict the survival rate of head injury patients with the SpO2 value. The method used was a prospective study with a cohort design. Samples were head injury patients who came to the ER without comorbidities. The instruments used were the Revised Trauma Score (RTS) and Oximetry. Patients who arrived at the ER were measured for their SpO2 levels, treated according to SOP, and 6 hours later, the survival rates were assessed. The sampling technique used was purposive sampling. The statistical test used is Somers’d Correlation Test. The sample consisted of 46 head injury patients with SpO2 in a good category of 30 (65.2%) and good survival of 32 (69.6%). SpO2 had a strong correlation with survival (p = 0.00; r = 0.846; RR = 8.16). Patients with good SpO2 were 8.16 times more survive than others. Low SpO2 can be used as an early indicator of tissue hypoxia and related to mortality. The ER nurse should be concerned about the patient's oxygen saturation and ensure that the SpO2 level is in the 95% -100% range.


INTRODUCTION
Head injury is the leading cause of disability and mortality worldwide, with traffic accidents was the biggest problem (Papadimitriou-Olivgeris et al., 2020).
This condition generally occurs in motorbike drivers without a helmet or wearing a not standard helmet (Marya et al., 2017). Head injury is a very lifethreatening condition associated with the initial level of brain damage and secondary pathology (Papadimitriou-Olivgeris et al., 2020). The mortality rate in head injury patients is classified into three parts, consisting of immediate deaths (in the first 1 hour), early deaths (in the first 24 hours), late deaths (after the first 24 hours) (Papadimitriou-Olivgeris et al., 2020).
Head injury ranks first in Indonesia, where victims of traffic accidents are 33.2%.
Based on the results of basic health research (RISKESDAS) in 2013, the total amount of data analyzed was 1,027,758 people for all ages. The respondents who had experienced injuries were 84,774 people, and 942,984 people were not injured. National injury prevalence is 8.2%, and head injury prevalence in North Sulawesi is 8.3%. The highest prevalence of injury based on the characteristics of the respondent was in the 15-24 year age group (11.7%) and men (10.1%) (Riskesdas, 2018).
The management of head injuries should start from the scene of the incident, during transportation, in the Emergency Department, to definitive therapy. Right, and fast treatment will affect the patient's survival rate (Dixon et al., 2020). The ability to predict head injury patients' mortality at an early stage can provide good information for the treatment in later stages (HoonLee et al., 2018). Head injury management's main goals are to optimize recovery from primary head injuries and prevent secondary head injuries (Dixon et al., 2020). In the primary survey treatment, the prioritized matters include Airway, Breathing, Circulation, Disability, and Exposure, followed by resuscitation (Dixon et al., 2020). Patients with head injuries often experience cardiopulmonary  (Sumarno, 2016).
Failure to supply oxygen within 5 minutes can result in permanent brain damage (Ostrowski, Pucko, and Matyja, 2020). An easy way to detect hypoxemia is by monitoring oxygen saturation levels to measure how much of the percentage of O2 hemoglobin can carry (Wijaya, 2013).
Monitoring oxygen saturation levels can be done by monitoring using a peripheral oxygen saturation oximetry (SpO2).
Monitoring the correct and appropriate peripheral oxygen saturation levels when acting, especially in head injury patients, can reduce poor clinical outcomes (Irmawan, 2017

RESULTS AND DISCUSSION
In the research process, data was collected on the respondents' characteristics such as age, gender, and work type. Factors related to head injury cases in patients were also identified, including the degree of head injury, the type of transportation used to deliver the patient to the emergency room, peripheral oxygen saturation of the patient, and the patient's clinical outcome.  (Kaye, 2015). Two-thirds of head injury cases occur in men more than women (Wolf-Maier et al., 2004).
Research in Iran shows that men suffer more injuries than women (Soertidewi, 2012 In this study, an assessment of the characteristics of the head injury of the respondents was conducted. Table 2 presents data related to the characteristics  (Filipescu et al., 2020). Adequate oxygenation is maintained in the patient to provide a good prognosis for the patient.
Hypoxic events, especially in the brain, can be avoided to prevent secondary injury to head injury patients (Vacchiano and Silva, 2017

Somers'd Test
Research conducted by Ratnasari (2015) stated that brain tissue oxygenation was closely related to several outcome parameters and patient prognosis. The application of interventional therapy to maintain brain tissue oxygenation above a certain threshold can improve mortality and neurological outcomes in brain injury patients (Stillwell, B., 2011). (Vacchiano and Silva, 2017) reported that the mortality rate was higher in patients with low brain tissue oxygenation. Several other studies reported that brain tissue hypoxia below ten mmHg was associated with poor outcomes after brain injury. The mortality rate was more than 50% in patients with brain tissue oxygenation of less than 10 mm Hg for 30 minutes (Ratnasari, 2015).