Trauma Commons^™

Longitudinal Change In Regional Brain Volumes With Exposure To Repetitive Head Impacts, Charles Bernick, Guogen Shan, Henrik Zetterberg, Sarah Banks, Virendra R. Mishra, Lynn Bekris, James B. Leverenz, Kaj Blennow

Environmental & Global Health Faculty Research

Objective This study tests the hypothesis that certain MRI-based regional brain volumes will show reductions over time in a cohort exposed to repetitive head impacts (RHI). Methods Participants were drawn from the Professional Fighters Brain Health Study, a longitudinal observational study of professional fighters and controls. Participants underwent annual 3T brain MRI, computerized cognitive testing, and blood sampling for determination of neurofilament light (NfL) and tau levels. Yearly change in regional brain volume was calculated for several predetermined cortical and subcortical brain volumes and the relationship with NfL and tau levels determined. Results A total of 204 participants who had …

Processing Trauma In The Hebrew Bible, Carol A. Mcmullen

Consensus

From a contemporary perspective, many of the colourful characters in the Hebrew Bible may have experienced various levels of trauma which affected their thoughts, feelings and behaviours as recorded in the text. As part of a scholarly tradition of applying modern diagnostic terminology to historical personalities, this study connects various Biblical stories to an implicit theme of trauma that runs through much of the larger Jewish narrative. Such exploration provides a unique perspective in contrast to more traditional biblical interpretations that have largely ignored these specific aspects of trauma. Strategies of coping, healing, survival, and resilience can be further gained …

Outcomes In Patients With Gunshot Wounds To The Brain, Leigh Anna Robinson, Lauren M. Turco, Bryce Robinson, Joshua G. Corsa, Michael Mount, Amy V. Hamrick, John Berne, Dalier R. Mederos, Allison G. Mcnickle, Paul J. Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K. Lee, Kevin L. Chow, Erik J. Olson, Jose L. Pascual, Rachele Solomon, Danielle A. Pigneri, Husayn A. Ladhani, Joanne Fraifogl, Terry Curry, Todd W. Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich

School of Medicine Faculty Research

Introduction: Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods: We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at …

Outcomes In Patients With Gunshot Wounds To The Brain., Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, John Berne, Dalier R Mederos, Allison G Mcnickle, Paul J Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K Lee, Kevin L Chow, Erik J Olson, Jose L Pascual, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, Robert D Winfield

Trauma and Acute Care Articles

INTRODUCTION: Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.

METHODS: We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at …

Intraoperative Reboa: An Analysis Of The American Association For The Surgery Of Trauma Aorta Registry., Michael A Vella, Ryan Peter Dumas, Joseph Dubose, Jonathan Morrison, Thomas Scalea, Laura Moore, Jeanette Podbielski, Kenji Inaba, Alice Piccinini, David S Kauvar, Valorie L Baggenstoss, Chance Spalding, Charles Fox, Ernest E Moore, Jeremy W Cannon, Aast Aorta Study Group

Trauma and Acute Care Articles

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality.

METHODS: The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury.

RESULTS: Location and timing of catheter insertion …

Picture Perfect: Pediatric Ct Utilization In Trauma, Laura Strickland, Christa Zino Md

Pediatrics

No abstract provided.

Surgical Stabilization Of Traumatic Flail Chest Is Superior To Conservative Management, Monique J. Cheng

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Marasco SF, Davies AR, Cooper J, et al. Prospective Randomized Controlled Trial of Operative Rib Fixation in Traumatic Flail Chest. Journal of the American College of Surgeons. 2013;216(5):924-932. doi: 10.1016/j.jamcollsurg.2012.12.024.

A Study Of Scars: Narratives Of Unintentional Childhood Injuries In Cato Manor, Carolyn Fox

Independent Study Project (ISP) Collection

The purpose of this study is to identify the specific types of injuries children experience growing up in Cato Manor, specifically, KwaMasxha, to understand how community members process and make meaning of their injuries over time, and to analyze the social determinants of health in Cato Manor that have been conducive to these injuries.

In order to learn about experiences of unintentional childhood injuries in Cato Manor, data was collected using a qualitative, narrative-based approach. I conducted interviews with young adult community members aged 19 to 27 years, asking about their personal experiences with childhood injuries as someone who grew …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Peripheral Vascular Injuries - Not To Miss Or Mess Them!, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Operative Versus Conservative Treatment Of Clavicular And Scapular Fractures, Chase Davis

Theses and Graduate Projects

Background: Clavicle fractures and scapula fractures represent up to 4% and 1% of all fractures, respectively.^1-4,9-11 Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.

Method: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for both clavicular and scapular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of nonunion.

Results: ORIF of midshaft clavicular fractures results in increased shoulder function within …

Lehigh Valley Hospital–Hazleton Trauma Pi Process, Alexandra K. Evans

Department of Medicine

No abstract provided.

Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance And Individual Differences On The Rotary Pursuit Task, Arianna Rigon, Nathaniel B. Klooster, Samantha Crooks, Melissa C. Duff

Communication Disorders Faculty Research

The impact of traumatic brain injury (TBI) on procedural memory has received significantly less attention than declarative memory. Although to date studies on procedural memory have yielded mixed findings, many rehabilitation protocols (e.g., errorless learning) rely on the procedural memory system, and assume that it is relatively intact. The aim of the current study was to determine whether individuals with TBI are impaired on a task of procedural memory as a group, and to examine the presence of individual differences in performance. We administered to a sample of 36 individuals with moderate-severe TBI and 40 healthy comparisons (HCs) the rotary …

Quality Of Life Of Road Traffic Injury Survivors Aged 15-44 Years Suffered From Moderate And Severe Head Injuries In Karachi, Pakistan, S A. Abbasi, Tazeen Saeed Ali, Shafquat Rozi, Uzma Rahim Khan, Rashid Jooma

Community Health Sciences

Background: Most of Road traffic injuries are predicted to be the third leading contributor to the global burden of disease by 2020 and patients end up into head injuries which leave devastating impacts on individual and society. Quality of Life After Brain Injury (QOLIBRI) is a specific tool that measures quality of life in head injury patients.
Methods: This was a cross sectional study among 300 patients aged 15-45 years, attended emergency department of the Aga khan University Hospital. Structured questionnaire included demography, injury details, QOLIBRI, GOSE and WHO Disability Assessment Scale (WHODAS 12 items). Severity of injury was determined …

Aseptic Loosening Of An Aptis Distal Radioulnar Joint Arthroplasty – Case Report, Karis Bennett, Srinath Kamineni

Orthopaedic Surgery and Sports Medicine Faculty Publications

Dysfunction of the distal radioulnar joint can cause significant pain and instability. The self-stabilizing APTIS distal radioulnar joint prosthesis is used as a solution for severe distal radioulnar joint pathologies. We present a case of a 60-year-old male, who received an APTIS distal radioulnar joint prosthesis which resulted in aseptic loosening within five years of the initial implantation. Infection, incorrect implantation, demographic differences and over-activity were all excluded as the source; therefore, mechanical aseptic loosening was concluded. Ultimately, two surgeries were required to resolve the patient's pain, which resulted in a one-bone forearm once the implant was extracted. The solution …

Expressive Mindfulness: A Trauma-Sensitive Expressive Arts Therapy Group Method, Meghan Daly

Expressive Therapies Capstone Theses

Mindfulness and expressive arts therapy are both supportive of directing attention in a manner that promotes integration and function of a person. In this paper, a trauma-sensitive method was created for use in a day treatment setting for adults with severe and persistent mental illness (SPMI). This method utilized expressive movement, visual art making with three different materials, and creative writing to encourage mindful, non-judgmental acceptance of the present moment; a sense of relaxation; and an overall increase in quality of life. During development of the method arts-based research informed the choice of materials, music, and structure of the group. …

Trauma Analysis From Rapid Staircase Descension, Srinanti Bhattacharya

CURCE Annual Undergraduate Conference

This experiment was designed after the release of the Netflix show called the “The Staircase.” A true documentary, a woman’s fall down the staircase results in her death, but the investigators question whether it was an accident or murder. The woman’s husband was initially accused of murder, but after a lengthy trial and the review of additional evidence, it was ruled an accident. In the autopsy results, there was evidence of blunt force trauma (Figure 1) inconsistent with an accidental fall. Therefore this research asks what is the difference in trauma from an accidental fall versus a intentional, assisted descent?

Traumatic Compartment Syndrome Of The Foot: A Case Report, Mansi Patel, Asim Qureshi, Matthew K. Brant

Rowan-Virtua Research Day

Compartment syndrome of the foot is a rare but limb threatening condition that is often difficult to diagnose. It is usually caused by traumatic injuries and the diagnosis requires a high clinical suspicion and timely management. Clinically, patients will present with an acute traumatic event followed by physical exam findings of non-palpable pulses, paralysis, pallor, pain out of proportion, and paresthesias. The foot contains nine compartments, which should be assessed independently for elevated pressures. The diagnostic threshold for each compartment is 30 mmHg. Pressures above this threshold require emergent fasciotomy to preserve the anatomical structures and thus the function of …

Cultural Work In Addressing Conflicts And Violence In Traumatized Communities, Eugen Koh

New England Journal of Public Policy

There is a growing appreciation that conflict and violence in many communities have their origins in a history of traumatic experiences. Why this link exists and how it comes about is still unclear. We have no unified psychology of traumatized communities, and little is known about how to address these traumatic origins collectively in these communities. This article proposes a psychodynamic model of collective trauma and a psychoanalytically informed approach to working with traumatized communities to address their issues of conflict and violence. It highlights the impact of collective trauma on the culture of a community, which is its collective …

Seerratus Anterior Plane Block (Sapb) Improves Paine Control In Rib Fractures, Randy Kring, Peter Croft, David Mackenzie, Christina Wilson, Joseph Rappold, Tania D. Strout

MaineHealth Maine Medical Center

Background:

•Trauma is a major cause of morbidity and mortality worldwide. Rib fractures are identified in at least 10% of all injured patients.

•Rib fractures can lead to significant respiratory complications, with pneumonia and respiratory failure occurring in up to 31% of patients with rib fractures. Early initiation of aggressive pain control and pulmonary hygiene with incentive spirometry are standard of care to prevent complications from developing.

•In the Emergency Department, patients with rib fractures typically receive systemic analgesia that is largely narcotic-based. This pain control strategy puts patients at risk for the side effects of narcotics such as constipation, …

Effects Of Exercise On Eeg Activity And Standard Tools Used To Assess Concussion, David M Devilbiss, Jena L Etnoyer-Slaski, Emily Dunn, Christopher R Dussourd, Mayuresh V Kothare, Stephen J Martino, Adam J Simon

Rowan-Virtua School of Osteopathic Medicine Departmental Research

A variety of cognitive assessment tools are used to determine the functional status of the brain before and after injury in athletes. Questionnaires, neuropsychological tests, and electroencephalographic (EEG) measures have been recently used to directly assess brain function on and near the playing field. However, exercise can affect cognitive performance and EEG measures of cortical activity. To date, little empirical evidence exists on the effects of acute exercise on these measures of neurological function. We therefore quantified athlete performance on a standardized battery of concussion assessment tools and EEG measurements immediately before and after acute exercise to simulate conditions of …

“Uno Logra Olvidar La Tortura”: Impactos De Las Dictaduras Militares Y Conversaciones Sobre Las Secuelas De La Tortura En El Instituto De Terapia E Investigación, Em Rosner

Independent Study Project (ISP) Collection

Investigué el impacto real de las dictaduras militares, y específicamente cómo las experiencias de tortura continuan marcando las vidas de los sobrevivientes y su habilidad de procesar los eventos de sus propias vidas, compartir sus experiencias con otras personas y hacer conexiones interpersonales. Mis preguntas primarias eran, ¿Cómo la tortura ha marcado la vida a largo plazo de las personas que la sufrieron? ¿Cómo impactan las experiencias de represión y tortura en las formas en que se construyen relaciones sociales y proyectos de vida? Para investigar este tema, entrevisté a personas que han tenido experiencias de tortura o que han …

Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker

Lesley University Community of Scholars Day

Human attachment is one of the most critical factors in proper neurological and physiological development. Attachment is built through the mutuality of emotional impact, as well as the regular reception of physical touch. Infants and children who have been deprived of these vital necessities through the lacking initiatives of their caregivers—through neglect—display visible signs of its physiological, cognitive, emotional, and behavioral impact. Research has found neglect to be the highest risk factor for permanent damage to brain development in comparison to other forms of complex trauma (i.e. chronic caregiver interpersonal trauma in childhood); it is also the most prevalent …

Air Of The Dog: Impending Respiratory Failure After A Dog Bite., Gregory Tanquary, Andrew Little, Juan A Morales-Torres

Trauma and Acute Care Articles

Animal and human bites represent a significant health issue worldwide. However, penetrating neck trauma secondary to animal bites is a rare presentation. We present the case of a 32-year-old female with neck pain and difficulty breathing after suffering a dog bite to the neck. Bedside ultrasound and subsequent computed tomography (CT) showed findings consistent with subcutaneous emphysema. Due to rapidly progressing neck swelling and stridor, she required advanced airway management followed by emergent exploratory surgery. We present a case report on impending respiratory failure after a dog bite and review the management of penetrating neck trauma.

Inferior Vena Cava Filter Clinic And Hospital Registry: One Year Review, Emily Keltner Bs, Ma, T. Eric White Md, Lisa Hollister

Parkview Heart Institute

Poster Presentation-

Background: Inferior vena cava (IVC) filters are small, cage-like devices placed percutaneously into the inferior vena cava to prevent propagation of thrombus into the pulmonary arteries. Currently, there are two available types of filters, permanent and temporary. Retrievable inferior vena cava (IVC) filter use has increased over 115% since the Food and Drug Administration (FDA) approval in 2009. Likewise, there has been a marked increase in complications related to their increased use. In 2014, the FDA initiated a comprehensive analysis of filter placement and issued the following recommendation: “The FDA recommends that implanting physicians and clinicians responsible for …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

A Proof-Of-Mechanism Study To Test Effects Of The Nmda Receptor Antagonist Lanicemine On Behavioral Sensitization In Individuals With Symptoms Of Ptsd, Marijn Lijffijt, Charles E Green, Nicholas Balderston, Tabish Iqbal, Megan Atkinson, Brittany Vo-Le, Bylinda Vo-Le, Brittany O'Brien, Christian Grillon, Alan C Swann, Sanjay J Mathew

Faculty, Staff and Students Publications

Background: Individuals with post-traumatic stress disorder (PTSD) have a heightened sensitivity to subsequent stressors, addictive drugs, and symptom recurrence, a form of behavioral sensitization. N-methyl-D-aspartate receptors (NMDARs) are involved in the establishment and activation of sensitized behavior.

Objective: We describe a protocol of a randomized placebo-controlled Phase 1b proof-of-mechanism trial to examine target engagement, safety, tolerability, and possible efficacy of the NMDAR antagonist lanicemine in individuals with symptoms of PTSD (Clinician Administered PTSD Scale [CAPS-5] score ≥ 25) and evidence of behavioral sensitization measured as enhanced anxiety-potentiated startle (APS; T-score ≥ 2.8).

Methods: Subjects (n = 24; age range 21–65) …