Trauma Commons^™

Geriatric Trauma Triage: Optimizing Systems For Older Adults-A Publication Of The American Association For The Surgery Of Trauma Geriatric Trauma Committee, Tanya Egodage, Vanessa P Ho, Tasce Bongiovanni, Jennifer Knight-Davis, Sasha D Adams, Jody Digiacomo, Elisabeth Swezey, Joseph Posluszny, Nasim Ahmed, Kartik Prabhakaran, Asanthi Ratnasekera, Adin Tyler Putnam, Milad Behbahaninia, Melissa Hornor, Caitlin Cohan, Bellal Joseph

Faculty, Staff and Student Publications

BACKGROUND: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation.

METHODS: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older …

Associations Of Chronic Pain With Psychosocial Outcomes After Traumatic Brain Injury: A Nidilrr And Va Tbi Model Systems Collaborative Project, Robin Hanks, Jessica M Ketchum, Mackenzie Peckham, Mitch Sevigny, Angelle M Sander, Aaron M Martin, Stephanie Agtarap, Cynthia L Beaulieu, Librada Callender, Flora M Hammond, Jean Lengenfelder, Amanda R Rabinowitz, William C Walker, Jeanne M Hoffman, Cynthia Harrison-Felix, Risa Nakase-Richardson

Faculty, Staff and Students Publications

OBJECTIVE: To examine the differences in participation, life satisfaction, and psychosocial outcomes among individuals with traumatic brain injury (TBI) endorsing current, past, or no chronic pain.

SETTING: Community.

PARTICIPANTS: Three thousand eight hundred four TBI Model Systems participants 1 to 30 years of age postinjury classified into 1 of 3 groups based on their pain experience: current pain, past pain, no pain completed a Pain Survey at their usual follow-up appointment which on average was approximately 8 years postinjury.

DESIGN: Multisite, cross-sectional observational cohort study.

MAIN OUTCOME MEASURES: Sociodemographic and injury characteristics and psychosocial outcomes (ie, satisfaction with life, depression, …

Reducing Stress After Trauma (Reset): Study Protocol For A Randomized, Controlled Trial Of An Online Psychoeducational Program And Video Therapy Sessions For Children Hospitalized After Trauma, Heather T Keenan, Shari L Wade, Devi Miron, Angela P Presson, Amy E Clark, Linda Ewing-Cobbs

Faculty, Staff and Student Publications

BACKGROUND: Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group.

METHODS: This is a randomized controlled trial to test the effectiveness of the ReSeT …

Early And Empirical High-Dose Cryoprecipitate For Hemorrhage After Traumatic Injury: The Cryostat-2 Randomized Clinical Trial, Ross Davenport, Nicola Curry, Erin E Fox, Helen Thomas, Joanne Lucas, Amy Evans, Shaminie Shanmugaranjan, Rupa Sharma, Alison Deary, Antoinette Edwards, Laura Green, Charles E Wade, Jonathan R Benger, Bryan A Cotton, Simon J Stanworth, Karim Brohi, Cryostat-2 Principal Investigators

Faculty, Staff and Student Publications

IMPORTANCE: Critical bleeding is associated with a high mortality rate in patients with trauma. Hemorrhage is exacerbated by a complex derangement of coagulation, including an acute fibrinogen deficiency. Management is fibrinogen replacement with cryoprecipitate transfusions or fibrinogen concentrate, usually administered relatively late during hemorrhage.

OBJECTIVE: To assess whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol.

DESIGN, SETTING, AND PARTICIPANTS: CRYOSTAT-2 was an interventional, randomized, open-label, parallel-group controlled, international, multicenter study. Patients were enrolled at 26 UK and US …

Identification Of Factors In Moderate-Severe Tbi Related To A Functional Decline In Cognition Decades After Injury, Christian Lobue, Jeff Schaffert, Kristen Dams-O'Connor, Zinat Taiwo, Angelle Sander, Umesh M Venkatesan, Therese M O'Neil-Pirozzi, Flora M Hammond, Kristin Wilmoth, Kan Ding, Kathleen Bell, C Munro Cullum

Faculty, Staff and Students Publications

OBJECTIVE: To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury.

DESIGN: Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI.

SETTING: TBI Model Systems Centers.

PARTICIPANTS: Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across 3 time points out to 20 years (visits at 2-, 10-, and 20-year follow-ups; N=732).

INTERVENTIONS: …

The Relationship Between Parental Trauma History And Perceptions Regarding Their Child’S Healthcare And Utilization Of Healthcare Services, Krishna Patel

Theses and Dissertations

Abstract

TITLE: The Relationship Between Parental Trauma History and Perceptions Regarding Their Child’s Healthcare and Utilization of Healthcare Services

Adverse child events (ACEs) have been associated with a number of physical and mental health problems and have also been linked to increased health care utilization. While parents who have an ACE history may tend to seek healthcare services for themselves, limited studies have examined the impact of their trauma history on seeking healthcare services for their child. Healthcare utilization may also depend on the parents’ level of health anxiety, as well as their anxiety about their child’s health status. This …

Hmg-Coa Reductase Inhibitors For Traumatic Brain Injury, Kalman Katlowitz, Shankar Gopinath, Jovany Cruz Navarro, Claudia Robertson

Faculty, Staff and Students Publications

Traumatic brain injuries (TBIs) are associated with high morbidity and mortality due to both the original insult as well as the destructive biological response that follows. Medical management aims to slow or even halt secondary neurological injury while simultaneously laying the groundwork for recovery. Statins are one class of medications that is showing increased promise in the management of TBI. Used extensively in cardiovascular disease, these drugs were originally developed as competitive inhibitors within the cholesterol production pipeline. They are now used in diverse disease states due to their pleiotropic effects on other biological processes such as inflammation and angiogenesis. …

Neighborhood Disadvantage And Neural Correlates Of Threat And Reward Processing In Survivors Of Recent Trauma, E. Kate Webb, Timothy D. Ely, Grace E. Rowland, Lauren A.M. Lebois, Sanne J.H. Van Rooij, Steven E. Bruce, Tanja Jovanovic, Stacey L. House, Francesca L. Beaudoin, Xinming An, Thomas C. Neylan, Gari D. Clifford, Sarah D. Linnstaedt, Laura T. Germine, Kenneth A. Bollen, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey, Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Brittany E. Punches, Robert A. Swor, Jose L. Pascual, Mark J. Seamon, Elizabeth M. Datner, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Paulina Sergot, Leon D. Sanchez, Ronald C. Kessler, Karestan C. Koenen, Samuel A. Mclean, Jennifer S. Stevens, Kerry J. Ressler, Nathaniel G. Harnett

Department of Emergency Medicine Faculty Papers

IMPORTANCE: Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry.

OBJECTIVE: To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, survivors of trauma who completed sociodemographic and posttraumatic symptom assessments and neuroimaging were recruited as part of the Advancing Understanding of Recovery After Trauma (AURORA) study between September 2017 and June 2021. Data …

The Dosing Of Mobile-Based Just-In-Time Adaptive Self-Management Prompts For Caregivers: Preliminary Findings From A Pilot Microrandomized Study, Jitao Wang, Zhenke Wu, Sung Won Choi, Srijan Sen, Xinghui Yan, Jennifer A Miner, Angelle M Sander, Angela K Lyden, Jonathan P Troost, Noelle E Carlozzi

Faculty, Staff and Students Publications

BACKGROUND: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood.

OBJECTIVE: The primary objective of this study is to evaluate the dose-response …

Poverty And Commercial Surrogacy In India: An Intersectional Analytical Approach, Sheela Suryanarayanan

Dignity: A Journal of Analysis of Exploitation and Violence

The destination and source countries for commercial surrogacy match world patterns of inequality. India, Nepal, Thailand, Mexico, and Cambodia banned commercial surrogacy, moving the market to other less-developed countries in South Africa and South America. India had a commercial surrogacy boom until exploitative factors led to the passage of the Surrogacy (Regulation) Bill in 2019, which banned the practice. This paper examines surrogacy's monetary, health, and emotional effects on 45 surrogate mothers in Gujarat State, India. The study revealed that a majority (63%) of the very poor women remained very poor post-surgery. Surrogate mothers in poor households had to do …

Early Prediction Of Massive Transfusion For Patients With Traumatic Hemorrhage: Development Of A Multivariable Machine Learning Model, Andrew J Benjamin, Andrew J Young, John B Holcomb, Erin E Fox, Charles E Wade, Chris Meador, Jeremy W Cannon

Faculty, Staff and Student Publications

OBJECTIVE: Develop a novel machine learning (ML) model to rapidly identify trauma patients with severe hemorrhage at risk of early mortality.

BACKGROUND: The critical administration threshold (CAT, 3 or more units of red blood cells in a 60-minute period) indicates severe hemorrhage and predicts mortality, whereas early identification of such patients improves survival.

METHODS: Patients from the PRospective, Observational, Multicenter, Major Trauma Transfusion and Pragmatic, Randomized Optimal Platelet, and Plasma Ratio studies were identified as either CAT+ or CAT-. Candidate variables were separated into 4 tiers based on the anticipated time of availability during the patient's assessment. ML models were …

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Faculty, Staff and Student Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Using Predictive Validity To Compare Associations Between Brain Damage And Behavior, John F Magnotti, Jaclyn S Patterson, Tatiana T Schnur

Faculty, Staff and Student Publications

Lesion-behavior mapping (LBM) provides a statistical map of the association between voxel-wise brain damage and individual differences in behavior. To understand whether two behaviors are mediated by damage to distinct regions, researchers often compare LBM weight outputs by either the Overlap method or the Correlation method. However, these methods lack statistical criteria to determine whether two LBM are distinct versus the same and are disconnected from a major goal of LBMs: predicting behavior from brain damage. Without such criteria, researchers may draw conclusions from numeric differences between LBMs that are irrelevant to predicting behavior. We developed and validated a predictive …

Coping Mechanisms During The Covid-19 Pandemic And Lockdown In Metropolitan Johannesburg, South Africa: A Qualitative Study, Nerli Paredes Ruvalcaba, Andrew Wooyoung Kim, Nokubonga Ndaba, Lindile Cele, Someleze Swana, Edna Bosire, Aneesa Moolla

Brain and Mind Institute

Background: The COVID-19 pandemic has caused prolonged stress on numerous fronts. While the acute health impacts of psychosocial stress due to the pandemic are well-documented, less is known about the resources and mechanisms utilized to cope in response to stresses during the pandemic and lockdown.

Objective: The aim of this study was to identify and describe the coping mechanisms adults utilized in response to the stressors of the COVID-19 pandemic during the 2020 South African lockdown.

Methods: This study included adults (n=47: 32 female; 14 male; 1 non-binary) from the greater Johannesburg region in South Africa. Interviews …

History Of Childhood Physical Abuse Is Associated With Gut Microbiota Diversity Among Adult Psychiatric Inpatients, Jessica C Rohr, Katelynn A Bourassa, Dominique S Thompson, J Christopher Fowler, B Christopher Frueh, Benjamin L Weinstein, Joseph Petrosino, Alok Madan

Faculty, Staff and Students Publications

BACKGROUND: Traumatic life events are associated with the development of psychiatric and chronic medical illnesses. This exploratory study examined the relationship between traumatic life events and the gut microbiota among adult psychiatric inpatients.

METHODS: 105 adult psychiatric inpatients provided clinical data and a single fecal sample shortly after admission. A modified version of the Stressful Life Events Screening Questionnaire was used to quantify history of traumatic life events. 16S rRNA gene sequencing was used to analyze the gut microbial community.

RESULTS: Gut microbiota diversity was not associated with overall trauma score or any of the three trauma factor scores. Upon …

Therapy Approaches Provided To Traumatized Refugee Children, Esther Ekeh

Independent Study Project (ISP) Collection

The study examined various trauma treatments provided to traumatized refugee children and evaluated their effectiveness. Interviews were conducted with five mental health professionals, comprising two males and three females. The professionals included a psychologist at Caritas, a coordinator at Syrian American Medical Society (SAMS), a manager of an international non-governmental organization (NGO), a clinical psychologist at the Happiness Again Project, and a psychologist at an NGO. All interviews were conducted in person. Thematic analysis was employed to analyze the interview data. The findings revealed that play therapy and group therapy emerged as the most effective trauma treatments for traumatized refugee …

The Influence Of Posttraumatic Stress Disorder Treatment On Anxiety Sensitivity: Impact Of Prolonged Exposure, Sertraline, And Their Combination, Matthew T Luciano, Sonya B Norman, Carolyn B Allard, Ron Acierno, Naomi M Simon, Kristin L Szuhany, Amanda W Baker, Murray B Stein, Brian Martis, Peter W Tuerk, Sheila A M Rauch, Progress Study Team

Faculty, Staff and Student Publications

Trauma-informed beliefs often decrease during posttraumatic stress disorder (PTSD) treatment. This may also extend to anxiety sensitivity (AS), defined as a fear of anxiety-related sensations and beliefs that anxiety is dangerous and/or intolerable. However, little is known about how AS changes during exposure-based and psychopharmacological PTSD treatments. Further, high AS may be a risk factor for diminished PTSD symptom improvement and increased treatment dropout. To better understand how AS impacts and is impacted by PTSD treatment, we conducted a secondary analysis of a randomized clinical trial with a sample of 223 veterans (87.0% male, 57.5% White) with PTSD from four …

The Behavioral Assessment Screening Tool For Mobile Health (Bastmhealth): Development And Compliance In Two Weeks Of Daily Reporting In Chronic Traumatic Brain Injury, Shannon B Juengst, Brittany Wright, Angelle M Sander, Samuel Preminger, Andrew Nabasny, Lauren Terhorst

Faculty, Staff and Students Publications

Objectives:

To develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BAST_mHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI).

Design:

Prospective, repeated measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a two-week period.

Setting:

Community

Participants:

Community-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study.

Interventions:

Not applicable

Main Outcome Measures:

BAST_mHealth subscales (2-items each): Negative Affect, Fatigue, …

Interpersonal Violence Against Women With Spinal Cord Injury: Adding Insult To Injury, Susan Robinson-Whelen, Rosemary B Hughes, Kimberley Aguillard, Diana Gonzalez, Heather B Taylor

Faculty, Staff and Student Publications

BACKGROUND: Mounting empirical evidence suggests that, compared to women without disabilities, women with disabilities are more likely to experience interpersonal violence (IPV). However, there is extremely limited research attention on IPV against women with spinal cord injury (SCI), a particularly understudied and underserved population.

OBJECTIVES: To conduct the first known examination of lifetime IPV experience in women with SCI, to explore demographic and disability-related correlates of IPV, and to examine the health impacts of IPV.

METHODS: The sample included 175 women with traumatic SCI from across the United States who enrolled in a randomized controlled trial of an online psychological …

Integrating Feminist Approaches In Counseling Work With Adult Women, Kristen M. Toole

Adultspan Journal

The scope of ‘women’s issues’ in counseling is an ever-evolving landscape. Recent events such as the reversal of Roe v. Wade and the disproportionate impact of COVID-19 on women serve as powerful reminders of the necessity of this focus while underscoring a deep-rooted history of oppressive patriarchal structures. Therefore, counselors must remain informed of the unique considerations surrounding adult women in counseling and acquire proficiency in versatile techniques to meet this population’s nuanced needs. This article examines the complexity of contemporary womanhood and explores the fundamentals of Feminist Counseling Theory (FCT), a holistic, multiculturally conscious, social justice theory in counseling. …

Are Trauma Surgeons Prepared? A Survey Of Trauma Surgeons’ Disaster Preparedness Before And During The Covid-19 Pandemic, Jay Doucet, David V Shatz, Lewis J Kaplan, Eileen M Bulger, Jeannette Capella, Deborah A Kuhls, Mary Fallat, Kyle N Remick, Christopher Newton, Adam Fox, Randeep Jawa, John A Harvin, David P Blake, Marko Bukur, Jonathan Gates, James Ficke, Mark L Gestring, The American Association For Surgery Of Trauma Disaster Committee

Faculty, Staff and Student Publications

OBJECTIVE: US trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency Medical Services (EMS) agencies, and stressed TCs. This survey assessed trauma surgeons' MCI training, experience, and system and personal preparedness before the pandemic compared with the pandemic's third year.

METHODS: Survey invitations were emailed to all 1544 members of the American Association for the Surgery of Trauma in 2019, and then resent in 2022 to 1575 members with additional questions regarding the pandemic. Questions assessed practice type, TC characteristics, …

The Gpcr–Gαs–Pka Signaling Axis Promotes T Cell Dysfunction And Cancer Immunotherapy Failure, Heather R Kregel, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

No abstract provided.

Rates And Risk Factors For Anastomotic Leak Following Blunt Trauma-Associated Bucket Handle Intestinal Injuries: A Multicenter Study, Holly Grossman, Chathurka Samudani Dhanasekara, Kripa Shrestha, Brianna Marschke, Erin Morris, Robyn Richmond, Ara Ko, Lakshika Tennakoon, Eric M Campion, Frank C Wood, Maggie Brandt, Grace Ng, Justin L Regner, Stacey L Keith, Michelle K Mcnutt, Heather Kregel, Rajesh R Gandhi, Thomas J Schroeppel, Daniel R Margulies, Yassar M Hashim, Joseph Herrold, Mallory Goetz, Lerone Simpson, Xuan-Lan Doan, Sharmila Dissanaike

Faculty, Staff and Student Publications

OBJECTIVES: The risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.

METHODS: This is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021. Baseline patient characteristics, risk factors, presence of shock and transfusion, operative details, and clinical outcomes were compared using R.

RESULTS: Data on 395 subjects were submitted by 12 trauma centers, of whom 33 (8.1%) patients developed AL. Baseline details were similar, except for a higher proportion …

Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury In Children And Adolescents, Jeffrey E Max, Imogen Drake, Florin Vaida, John R Hesselink, Linda Ewing-Cobbs, Russell J Schachar, Sandra B Chapman, Erin D Bigler, Elisabeth A Wilde, Ann E Saunders, Tony T Yang, Olga Tymofiyeva, Harvey S Levin

Faculty, Staff and Student Publications

OBJECTIVE: To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI).

METHODS: Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence …

One-Stage Flexor Reconstruction With Anterolateral Thigh And Fascia Lata Rolls After High-Voltage Trauma: A Case Report, Michael M Talanker, Kasra N Fallah, Cassie A Hartline, Daniel J Freet

Faculty, Staff and Student Publications

BACKGROUND: Electrical injuries from high-voltage power lines are unique forms of trauma that can create challenging wounds for reconstructive surgeons. Our patients, a man in his late thirties (Patient 1) and a man in his early twenties (Patient 2), both sustained upper extremity injuries after contact with a high-voltage line.

METHODS: Despite minimal superficial damage, both patients required fasciotomies and debridement of the volar forearm, revealing segmental defects in most digital tendons as well as the distal median nerve. Free fasciocutaneous anterolateral thigh (ALT) flaps were harvested to ensure adequate wound coverage. Additionally, fascia lata grafts were taken from the …

The Association Between Payer Source And Traumatic Brain Injury Rehabilitation Outcomes: A Tbi Model Systems Study, Anthony H Lequerica, Angelle M Sander, Monique R Pappadis, Jessica M Ketchum, Marissa Jaross, Stephanie Kolakowsky-Hayner, Amanda Rabinowitz, Librada Callender, Michelle Smith

Faculty, Staff and Students Publications

OBJECTIVE: To examine the relationship between payer source for acute rehabilitation, residential median household income (MHI), and outcomes at rehabilitation discharge after traumatic brain injury (TBI).

SETTING: Acute inpatient rehabilitation facilities.

PARTICIPANTS: In total, 8558 individuals enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who were admitted to inpatient rehabilitation between 2006 and 2019 and were younger than 64 years.

DESIGN: Secondary data analysis from a multicenter longitudinal cohort study.

MAIN MEASURES: Payer source was divided into 4 categories: uninsured, public insurance, private insurance, and workers' compensation/auto. Relationships between payer source with residential MHI, rehabilitation length of …

Specialized Intensive Inpatient Rehabilitation Is Crucial And Time-Sensitive For Functional Recovery From Disorders Of Consciousness, Bei Zhang, Katherine O'Brien, Jean Woo, Bradley Chi, Colton Reeh, Sheng Li, Sunil Kothari

Faculty, Staff and Students Publications

BACKGROUND: Disorders of consciousness (DoCs) after severe brain injury are considered to be conditions with dire prognosis. Despite the accumulating evidence, inpatient rehabilitation is often denied by payers referring to the Medicare/Medicaid criteria, under the assumption that such patients will not "

OBJECTIVE: This study aimed to report on the effectiveness and efficiency of a specialized inpatient DoC rehabilitation program based on measurable clinical parameters.

METHODS: A retrospective cohort study was conducted. The cohort comprised 137 patients with DoC admitted to a specialized acute inpatient rehabilitation program between January 2014 and October 2018. Patients were categorized as having been admitted …

Cerebral Microdialysis And Glucopenia In Traumatic Brain Injury: A Review, Himanshu Sharma, John P Mcginnis, Katherine E Kabotyanski, Shankar P Gopinath, Jerry C Goodman, Claudia Robertson, Jovany Cruz Navarro

Faculty, Staff and Students Publications

Traditionally, intracranial pressure (ICP) and partial brain tissue oxygenation (PbtO2) have been the primary invasive intracranial measurements used to guide management in patients with severe traumatic brain injury (TBI). After injury however, the brain develops an increased metabolic demand which may require an increment in the oxidative metabolism of glucose. Simultaneously, metabolic, and electrical dysfunction can lead to an inability to meet these demands, even in the absence of ischemia or increased intracranial pressure. Cerebral microdialysis provides the ability to accurately measure local concentrations of various solutes including lactate, pyruvate, glycerol and glucose. Experimental and clinical data demonstrate that such …

Unsheltered Homeless And Unstably Housed Adults Have Higher Levels Of Stress And More Health Risk Factors Than Sheltered Homeless Adults, Chaelin K Ra, Emily T Hébert, Adam Alexander, Darla E Kendzor, Robert Suchting, Michael S Businelle

Faculty, Staff and Student Publications

In the United States, approximately 580,000 individuals were homeless on a single night in 2020. Homelessness can be categorized into three subgroups: sheltered homeless, unsheltered homeless, and unstably housed. Few studies have examined the relations between homelessness subtypes, shelter service utilization, levels of stress experienced, and health risk factors. This study aimed to empirically examine whether shelter status the previous night was related to current stress, recent utilization of shelter-based mental health services, and current health risk factors. Data were collected at multiple homeless shelters in 2016 in the Oklahoma City area (N=575). All participants completed assessments of demographic characteristics, …