Trauma Commons^™

Free Flap Reconstruction Following Head And Neck Trauma, Larissa Sweeny, Anne C. Kane, Carissa M. Thomas, Neal Futran, Joseph M. Curry, Andrés M. Bur, G. Nina Lu, Aishwarya Shukla, Hunter Skoog, Jaime A. Pena Garcia, Angela E. Alnemri, Rahul Alapati, Michael Dileo, Andrew Fuson, Kenneth Tan, Farshid Taghizadeh, Gina D. Jefferson, Daniel Petrisor, Mark K. Wax

School of Medicine Faculty Publications

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon. Methods: Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103). Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day …

Examining Enrollment & Engagement In A Hospital-Based Violence Prevention Intervention Study At A Level 1 Trauma Center, Leigh Frederick

Electronic Theses and Dissertations

BACKGROUND: Violence is a significant healthcare issue that affects the health and well-being of individuals, families, and communities. Violence prevention and intervention programs are a powerful way to stop the revolving door of violent injury in our hospitals and communities. The Health Alliance for Violence Intervention (HAVI), develops and connects violence intervention programs, promotes equity for victims of violence globally, and is dedicated to engaging patients during the window of opportunity when they are recovering in the hospital after a violent injury to reduce the chance of retaliation (related to the injury) and recurrence. A small body of research shows …

Injuries Related To Waterskiing Between 2012 And 2022: A National Database Study., Sean M Muir, Tyler Rizzieri, Andrew Brown, Cole Graham, Laken Fulmer, Ryan Scagliarini, Kristine Lombardozzi

Trauma and Acute Care Articles

We conducted an epidemiological study by using the National Electronic Injury Surveillance System (NEISS) database to assess and quantify waterskiing injuries between 2012 and 2022. A total of 898 injuries were reported, primarily among Caucasian males during competition. Head (177, 20%), face (93, 10%), and knee (70, 8%) were the most prevalent types of injuries. Common physical examination findings included muscle strains, ligament sprains, lacerations, and fractures. Although rare, there were reported cases of dental injury, hemorrhage, crushing, foreign body, and amputation as well. These findings suggest that protective equipment, particularly headgear, is necessary to reduce the incidence of waterskiing …

Association Between Participation And Satisfaction With Life Over Time In Older Adults With Traumatic Brain Injury: A Tbi Model Systems Study, Zinat Taiwo, Angelle M Sander, Shannon B Juengst, Xiangyi Liu, Luis Leon Novelo, Flora M Hammond, Therese M O'Neil-Pirozzi, Paul B Perrin, Nicholas Gut

Faculty, Staff and Student Publications

Objective: To examine the association between participation and satisfaction with life at 1, 2, 5, and 10 years after traumatic brain injury (TBI) in older adults.

Setting: Community.

Participants: Participants ( N = 2362) who sustained complicated mild to severe TBI, requiring inpatient rehabilitation, at age 60 years or older and had follow-up data on participation and satisfaction with life for at least 1 follow-up time point across 1, 2, 5, and 10 years. Age at each time period was categorized as 60 to 64 years, 65 to 75 years, and 75 years or older.

Design: Secondary data analysis of …

Surgical Opportunism For Hand Reconstruction Following A Mutilating Injury: A Case Report., Krishna A Patel, Tuna Özyurekoglu

Trauma and Acute Care Articles

We report our management of a 53-year-old female who suffered a wood planer hand-mutilating injury with significant dorsal soft tissue loss and partial metacarpophalangeal joint (MCPJ) amputations of the thumb, index, and middle fingers. The middle finger was deconstructed for "spare parts" and a vascularized osteochondral graft was utilized to reconstruct the metacarpal articular surface of the index finger proximal phalanx, allowing the pedicled transposition of the index finger to the third metacarpal. The middle finger's distal interphalangeal joint was transplanted non-vascularly to recreate the thumb MCPJ and the elevation of a middle finger fillet flap allowed dorsal wound coverage. …

Does The Use Of Double Hormone Replacement Therapy For Trauma Patient Organ Donors Improve Organ Recovery For Transplant, Eden M. Gallegos, Tanner Reed, Paige Deville, Blake Platt, Claudia Leonardi, Lillian Bellfi, Jessica Dufrene, Saad Chaudhary, John Hunt, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alan Marr, Anil Paramesh, Alison A. Smith

School of Graduate Studies Faculty Publications

BACKGROUND With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients. AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients. METHODS A retrospective review …

Roadside Head Trauma In A Middle-Aged Man, Ian Michael Crimmins, David Isaac Beran

School of Medicine Faculty Publications

No abstract provided.

Neuroinflammation In Alzheimer’S Disease Mouse Brain Following Repetitive Mild Traumatic Brain Injury, Lujain Almuhanna

Electronic Theses and Dissertations

Traumatic brain injuries (TBIs) are a common form of head injury, with mild TBIs (mTBIs) making up 75-90% of the TBI severity scale. It’s been suggested that repetitive mild TBIs (rmTBIs) may enhance effects of Alzheimer’s Disease (AD). With dementia linking TBI and AD together, we investigated the memory hub of the brain - the hippocampus. Astrocytes and microglia are two glial cells that respond to neuroinflammation and therefore imaged in hippocampal regions of the 3xTg-AD mouse brain. We hypothesized that AD brain pathology (i.e., neuroinflammation) would be accelerated in 3xTg-AD mice following rmTBIs early in life. Analyses revealed that …

A Phase 3b, Open-Label, Single-Arm, Multicenter, Expanded-Access Study Of The Safety And Clinical Outcomes Of Stratagraft® Treatment In Adults With Deep Partial-Thickness Thermal Burns, James H. Holmes Iv, Angela L.F. Gibson, Tracee Short, Victor C. Joe, Jeffrey Litt, Joshua Carson, Jeffrey E. Carter, Lucy Wibbenmeyer, Helen Hahn, Janice M. Smiell, Randi Rutan, Richard Wu, Jeffrey W. Shupp

School of Medicine Faculty Publications

Background: A phase 3b, open-label, multicenter, expanded-access study (NCT04123548) evaluated safety and clinical outcomes of StrataGraft treatment in adults with deep partial-thickness thermal burns with intact dermal elements. Methods: Adult patients with 3 % to < 50 % total body surface area burns were treated with a single application of ≤ 1:1 meshed StrataGraft and followed for 24 weeks. Primary endpoint was count and percentage of patients with treatment-emergent adverse events (TEAEs). Secondary endpoints included confirmed wound closure (WC) at Week 12, durable WC at Week 24, time to WC, scar evaluation, and wound infection-related events. Results: Fifty-two patients with 96 treatment sites were enrolled. Pruritus was the most common TEAE (22 patients [42.3 %]). Twenty serious TEAEs occurred in 10 patients (19.2 %); none were related to StrataGraft. There were 4 (7.7 %) deaths (aspiration, myocardial infarction, self-injury, Gram-negative rod sepsis); none were related to StrataGraft. Confirmed WC was achieved by Week 12 in 33 patients (63.5 %; 95 % CI: 50.4–76.5 %) and 69 treatment sites (71.9 %; 95 % CI: 62.9–80.9 %). Durable WC was achieved by Week 24 in 29 patients (55.8 %; 95 % CI: 42.3–69.3 %) and 58 treatment sites (60.4 %; 95 % CI: 50.6–70.2 %). Conclusions: StrataGraft demonstrated clinical benefit. Safety data were consistent with previously reported findings.

Perturbations In Risk/Reward Decision Making And Frontal Cortical Catecholamine Regulation Induced By Mild Traumatic Brain Injury, Christopher P Knapp, Eleni Papadopoulos, Jessica A Loweth, Ramesh Raghupathi, Stan B Floresco, Barry D Waterhouse, Rachel L Navarra

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior. Little is known regarding the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. The present study characterized the effects of rmTBI on risk/reward decision making behavior and catecholamine transmitter regulatory proteins within the PFC. Rats were exposed to sham, single (smTBI), or three closed-head controlled cortical impact (CH-CCI) injuries and …

Open Tibial Shaft Fracture Fixation Strategies: Intramedullary Nailing, External Fixation, And Plating, Michelle Shen, Nirmal Tejwani

Faculty, Staff and Student Publications

Tibial shaft fractures are one of the most common orthopaedic injuries. Open tibial shaft fractures are relatively common because of the paucity of soft tissue surrounding the bone. Despite the prevalence of these injuries, the optimal fixation strategy is still a topic of debate. The purpose of this article was to review the current literature on open tibial shaft fracture fixation strategies including intramedullary nailing, external fixation, and plating.

Suture Fixation Of Traumatic Rib Fracture Flail Segment With Klebsiella Osteomyelitis., Krishna Patel, Anthony N Rizzo, John Bach, William Devoe

Trauma and Acute Care Articles

We report the case of a 71-year-old male who initially presented with urosepsis and was found to have a rib fracture of his right 6th rib with a flail segment and an associated abscess. Given the concern for infection, surgical rib fixation with titanium plating was not pursued during the washout of his abscess and instead, he successfully underwent rib fracture stabilization with bilateral suture transfixation. He was continued on a prolonged course of antibiotics for Klebsiella pneumonia osteomyelitis and was discharged uneventfully with optimal pain control and adequate respiratory effort.

Once, I Was Very Very Scared And More: An Exploration Into Depictions Of Interpersonal Trauma In Children's Literature, Emma K. Siepmann

University Honors Theses

This thesis examines the ways in which experiences of interpersonal trauma are depicted in English-language contemporary literature for elementary-aged children (6-11 years). A review of academic literature suggests that interpersonal trauma can have devastating and ongoing repercussions for individuals and their communities, although establishing a sense of relational safety can help mitigate these effects and facilitate healing after a traumatic experience. This research explores age-appropriate literature as a therapeutic tool for developing relational safety and providing critical skills to children at risk for and recovering from interpersonal trauma. This study analyzes the depictions of interpersonal trauma found in 11 picture …

Evaluation And Treatment Of Gastrointestinal Bleeding In Patients Taking Anticoagulants Presenting To The Emergency Department., Adam J Singer, Neena S Abraham, Latha Ganti, W Frank Peacock, Janaé Dark, Hajirah Ishaq, Ana Negrete, Brandon Mount, James Neuenschwander

Trauma and Acute Care Articles

This manuscript is a consensus document of an expert panel on the Evaluation and Treatment of Gastrointestinal Bleeding in Patients Taking Anticoagulants Presenting to the Emergency Department, sponsored by the American College of Emergency Physicians.

A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood

Adultspan Journal

Adult cancer survivors represent an important–and growing–population that could benefit from counseling services. This study employed consensual qualitative research to examine the well-being experiences of eight cancer survivors. Findings suggest a broad range of changes to individual well-being following cancer diagnosis and treatment, and indicate counseling can provide an ideal setting for processing such changes. Recommendations for counseling practice and future research are provided.

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Neurorehabilitation With Vagus Nerve Stimulation: A Systematic Review, Radha Korupolu, Alyssa Miller, Andrew Park, Nuray Yozbatiran

Faculty, Staff and Student Publications

OBJECTIVE: To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI).

METHODS: Data sources: PubMed, EMBASE, SCOPUS, and Cochrane.

STUDY SELECTION: Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery.

DATA EXTRACTION: Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically.

DATA SYNTHESIS: Twenty-nine studies were included; 11 were animal models of stroke, TBI, and …

Evaluation Of Sleep Outcomes After Traumatic Brain Injury In Children Using Questionnaires And Actigraphy, Connie Tran, Sydney Weese, Cydni Williams Md

Student Research Symposium

Traumatic brain injuries are the result of a sudden external blunt force to the brain and can result in long-term complications or death. In pediatrics, it is the leading cause of acute and chronic sleep wake disturbances, as well as cognitive deficits, which can lead to a reduction in the quality of life. These impairments can later result in lowered performance in work and school settings or decreased psychosocial function. Although there is sufficient evidence that traumatic brain injuries contribute to is that it is unknown whether or not sleep wake disturbances contribute to an increase in the mentioned cognitive …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Autologous Bone Marrow Mononuclear Cells To Treat Severe Traumatic Brain Injury In Children, Charles S Cox, David M Notrica, Jenifer Juranek, Jeffrey H Miller, Fabio Triolo, Steven Kosmach, Sean I Savitz, P David Adelson, Claudia Pedroza, Scott D Olson, Michael C Scott, Akshita Kumar, Benjamin M Aertker, Henry W Caplan, Margaret L Jackson, Brijesh S Gill, Robert A Hetz, Michael S Lavoie, Linda Ewing-Cobbs

Faculty, Staff and Student Publications

Autologous bone marrow mononuclear cells (BMMNCs) infused after severe traumatic brain injury have shown promise for treating the injury. We evaluated their impact in children, particularly their hypothesized ability to preserve the blood–brain barrier and diminish neuroinflammation, leading to structural CNS preservation with improved outcomes.

We performed a randomized, double-blind, placebo-sham-controlled Bayesian dose-escalation clinical trial at two children's hospitals in Houston, TX and Phoenix, AZ, USA (NCT01851083). Patients 5–17 years of age with severe traumatic brain injury (Glasgow Coma Scale score ≤ 8) were randomized to BMMNC or placebo (3:2). Bone marrow harvest, cell isolation and infusion were …

Management Strategies For Traumatic Injuries In Pregnant Women: A Comprehensive Literature Review, Jaylyn D. Thompson, Jenna Zappetti, Clarence Julian Clark Ii

Rowan-Virtua Research Day

Introduction: Traumatic injuries in pregnant women are the leading cause of non-obstetric death and affect 6% to 8% of all pregnancies. Therefore, it is imperative to maintain updated guidelines to construct a framework for the optimal management strategies for traumatic injuries in pregnant women, considering the perspectives of obstetrics/gynecology, emergency medicine, and orthopedics.

Methods: To conduct this study, research was done via a database search through the Rowan-Virtua School of Osteopathic Medicine’s research library. PubMed was the sole database used to review 8 peer-reviewed sources. Articles that were published within the last 10 years were chosen.

Results: Every woman with …

The Impact Of Traumatic Brain Injury On Noradrenergic Innervation Of The Prefrontal Cortex, Jil P. Modi, Christopher P. Knapp, Rachel L. Navarra

Rowan-Virtua Research Day

Traumatic Brain Injury (TBI) is a common cause of death and disability in the United States, and it can occur due to varied reasons including motor vehicle accidents, gunshot wounds, and falls. Following TBIs, patients are often left with lifelong disabilities and cognitive problems that can lead to increased risk-taking behaviors. The main goal of my research was to understand the neural mechanisms that drive increased risk-taking behaviors due to TBIs. The specific areas of the brain I was interested in looking at were the medial prefrontal cortex (mPFC), orbitofrontal cortex (OFC), and/or anterior cingulate cortex (ACC) of the prefrontal …

Barriers And Facilitators To Kinship Care In Texas: A Multi-Stakeholder, Mixed Methods Perspective, Lauren Malthaner, Jill Mcleigh, Hilda Loria, Erinne Conner, Mike Henson-Garcia

Caregiver Needs and Supports

Kinship caregivers face numerous barriers to providing care for children placed with them and limited facilitators to help ensure successful placements. Although the needs of kinship caregivers are being examined and prioritized in the legislature, operational and policy-level interventions are needed. Results from this study allow for interventions tailored to the needs of kinship caregivers in the State of Texas as identified by a multitude of stakeholder groups.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Treatments Perceived To Be Helpful For Neuropathic Pain After Traumatic Spinal Cord Injury: A Multicenter Cross-Sectional Survey Study, Thomas N Bryce, Chung-Ying Tsai, Andrew D Delgado, Sara J Mulroy, Abigail Welch, Diana D Cardenas, Heather B Taylor, Elizabeth R Felix

Faculty, Staff and Student Publications

DESIGN: Cross-sectional survey.

OBJECTIVE: To evaluate the perceived helpfulness of pharmacological and non-pharmacological interventions and their combinations for neuropathic pain (NeuP) and subcategories of NeuP after spinal cord injury (SCI).

SETTING: Six Spinal Cord Injury Model System Centers.

METHODS: Three hundred ninety one individuals at least one year post traumatic SCI were enrolled. A telephone survey was conducted to determine the pharmacologic and non-pharmacologic treatments used in the last 12 months for each participant's three worst pains, whether these treatments were "helpful", and if currently used, each treatments' effectiveness.

RESULTS: Two hundred twenty participants (56%) reported 354 distinct NeuPs. Pharmacological …

The Employment Of Resuscitative Endovascular Balloon Occlusion Of The Aorta In Deployed Settings, Branson D. Taheri, Andrew D. Fisher, Ian F. Eisenhauer, Michael D. April, Julie A. Rizzo, Sundeep S. Guliani, Kathleen M. Flarity, Michael Cripps, Vikhyat S. Bebarta, Max V. Wohlauer, Steven G. Schauer

Faculty Publications

Excerpt: We identified 17 cases of REBOA placed in combat settings from 2017 to 2019. The majority of these were placed in the operating room (76%) and in civilian patients (70%).

Examining The Effect Of Genes On Depression As Mediated By Smoking And Modified By Sex, Kirsten Voorhies, Julian Hecker, Sanghun Lee, Georg Hahn, Dmitry Prokopenko, Merry-Lynn Mcdonald, Alexander C Wu, Ann Wu, John E Hokanson, Michael H Cho, Christoph Lange, Karin F Hoth, Sharon M Lutz

Faculty, Staff and Student Publications

Depression is heritable, differs by sex, and has environmental risk factors such as cigarette smoking. However, the effect of single nucleotide polymorphisms (SNPs) on depression through cigarette smoking and the role of sex is unclear. In order to examine the association of SNPs with depression and smoking in the UK Biobank with replication in the COPDGene study, we used counterfactual-based mediation analysis to test the indirect or mediated effect of SNPs on broad depression through the log of pack-years of cigarette smoking, adjusting for age, sex, current smoking status, and genetic ancestry (via principal components). In secondary analyses, we adjusted …

An Analysis Of Burn Icu Days From The National Injury Resource Database, Anastasiya Ivanko, Jonathan E. Schoen, William L. Hickerson, Herb A. Phelan Iii, Bart D. Phillips, Jeffery E. Carter, Denise Danos

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

The Burden Of Burns: An Analysis Of Public Health Measures, Anastasiya Ivanko, Anna Garbuzov, Jonathan E. Schoen, Randy S. Kearns, Denise Danos, Erica Murata, Bart D. Phillips, Herb A. Phelan Iii, Jeffrey D. Carter

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Old Dog, New Tricks? Applying The Causal Hazard Chain Model To Burn Prevention And Injuries, Randy D. Kearns, Jeffrey E. Carter, Ernest Grant, W.L. Hickerson

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Using Implementation Science To Understand Barriers To Telemedicine Use For Burn Care During A Crisis, Amanda Bettencourt, Jeffrey E. Carter, Theresa M. Davis, Katherine R. Buhikire, Joseph Rhodes, Subhash Aryal, Gary Vercruysse, Deena Kelly-Costa, Colleen M. Ryan

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL