Several studies [1][2][3][4] have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. Accurate assessment of prognosis is crucial in multi-casualty incidents so that prehospital emergency care practitioners can focus their attention on patients predicted to have a good outcome. No single prognostic model is practised broadly despite many models being described in the literature. Most models are derived from developed nations, which potentially offer superior intensive healthcare services Background. Several studies have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. However, reliable predictive models are lacking for resource-limited prehospital settings such as those in developing countries like South Africa. Objective. To develop a simple predictive model for severe TBI using clinical variables in a South African prehospital setting. Methods. All consecutive patients admitted at two level-one centres in Cape Town, South Africa, for severe TBI were included. A binary logistic regression model was used, which included three predictor variables: oxygen saturation (SpO 2 ), Glasgow Coma Scale (GCS) and pupil reactivity. The Glasgow Outcome Scale was used to assess outcome on hospital discharge. Results. A total of 74.4% of the outcomes were correctly predicted by the logistic regression model. The model demonstrated SpO 2 (p=0.019), GCS (p=0.001) and pupil reactivity (p=0.002) as independently significant predictors of outcome in severe TBI. Odds ratios of a good outcome were 3.148 (SpO 2 ≥90%), 5.108 (GCS 6 -8) and 4.405 (pupils bilaterally reactive). Conclusion. This model is potentially useful for effective predictions of outcome in severe TBI.
Prehospital intubation did not demonstrate improved outcomes over basic airway management in patients with severe TBI. A large prospective, randomised trial is warranted to yield some insight into how these airway interventions influence outcome in severe TBI.
Student success is an enormous concern in light of the high drop-out rates in South African universities. There is a wealth of local and international research which provides complex explanations for these statistics, but the common-sense understanding is that those students who have the right attributes and who work hard will do well. While the notion of higher education as a meritocracy is pervasive, it is invalid given the effects of numerous other mechanisms at play in the students' educational experiences. This article draws from the literature to discuss the problems of the meritocratic explanation in how it fails to sufficiently account for the centrality of agency and the ways in which this intersects with societal structures. We argue that more useful understandings of student success and failure require social theory that acknowledges the complexities underpinning student success or failure.
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