Trauma Commons^™

Global Trends In Adolescents' Road Traffic Injury Mortality, 1990-2019, Uzma Rahim Khan, Junaid A. Razzak, Martin Gerdin Wärnberg

Department of Emergency Medicine

Objective: The aim of this study was to determine the trends of road traffic injury (RTI) mortality among adolescents aged 10-14 years and 15-19 years across different country income levels with respect to the type of road users from 1990 to 2019.
Methods: We conducted an ecological study. Adolescents' mortality rates from RTIs at the level of high-income countries (HICs), upper-income to middle-income countries (UMICs), lower-income to middle-income countries and low-income countries were extracted from the Global Burden of Disease study. Time series were plotted to visualise the trends in mortality rates over the years. We also conducted Poisson regression …

Docosanoid Signaling Modulates Corneal Nerve Regeneration: Effect On Tear Secretion, Wound Healing, And Neuropathic Pain, Thang L. Pham, Haydee E P Bazan

School of Medicine Faculty Publications

The cornea is densely innervated, mainly by sensory nerves of the ophthalmic branch of the trigeminal ganglia (TG). These nerves are important to maintain corneal homeostasis, and nerve damage can lead to a decrease in wound healing, an increase in corneal ulceration and dry eye disease (DED), and neuropathic pain. Pathologies, such as diabetes, aging, viral and bacterial infection, as well as prolonged use of contact lenses and surgeries to correct vision can produce nerve damage. There are no effective therapies to alleviate DED (a multifunctional disease) and several clinical trials using ω-3 supplementation show unclear and sometimes negative results. …

Testicular Dislocation After Unstable Pelvic Ring Injury., Zachary Bernhard, Devon Myers, Braden J Passias, Benjamin C Taylor, Joaquin Castaneda

Trauma and Acute Care Articles

Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries. Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) …

Accuracy Of Procalcitonin Levels For Diagnosis Of Culture-Positive Sepsis In Critically Ill Trauma Patients: A Retrospective Analysis, Aisha Bakhtiar, Syed Jawad Haider Kazmi, Muhammad Sohaib Asghar, Muhammad Nadeem Khurshaidi, Salman Mazhar, Noman A. Khan, Nisar Ahmed, Farah Yasmin, Rabail Yaseen, Maira Hassan

Section of Cardiothoracic Surgery

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. …

Upper Extremity Hematoma: An Atypical Case Of Compartment Syndrome., Nicholas Cowell, Andrew Kalnow

Trauma and Acute Care Articles

Compartment syndrome is a potentially life- or limb-threatening condition that carries high morbidity if not promptly diagnosed and treated. This case is an atypical presentation demonstrating why a high index of suspicion, prompt surgical consultation, and intervention is required if compartment syndrome is suspected.

Altered Physiology Of Gastrointestinal Vagal Afferents Following Neurotrauma, Emily N. Blanke, Gregory M. Holmes, Emily M. Besecker

Health Sciences Faculty Publications

The adaptability of the central nervous system has been revealed in several model systems. Of particular interest to central nervous system-injured individuals is the ability for neural components to be modified for regain of function. In both types of neurotrauma, traumatic brain injury and spinal cord injury, the primary parasympathetic control to the gastrointestinal tract, the vagus nerve, remains anatomically intact. However, individuals with traumatic brain injury or spinal cord injury are highly susceptible to gastrointestinal dysfunctions. Such gastrointestinal dysfunctions attribute to higher morbidity and mortality following traumatic brain injury and spinal cord injury. While the vagal efferent output remains …

Transitioning From Foster Care To Adulthood: Supporting Adolescents And Young Adults, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children involved in foster care have significant trauma histories and have often experienced substantial neglect and/or abuse. Such adverse childhood experiences can lead to cumulative toxic stress, which if not buffered by support and a consistent adult caregiver, can negatively impact physical, mental and socio-emotional development. Such experiences can also result in a lack of trust in adults and systems of care, which can further reduce sources of support for children in foster care.

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

childrens.com/fostercare

Development Of An Integrated Medical And Behavioral Health Care Model For Children In Foster Care: The Rees-Jones Center For Foster Care Excellence, Kimberly Stone, Sara Moore, Sara Pollard

Integrated, Trauma-Informed Care

Children in foster care are classified as a population with special health care needs. They face multiple adverse childhood experiences and disrupted relationships, yet face barriers accessing consistent, high-quality health care. The American Academy of Pediatrics recommends integrated physical and behavioral health care for children in foster care, but little is known about the implementation of integrated care for this population. As a pediatrician, doctor of nursing practice, and psychologist in an academic medical setting, we describe the development and implementation of the Rees-Jones Center for Foster Care Excellence, emphasizing the role of medical and behavioral health providers in promoting …

Empowerment Pathways: A Mitigation Approach To Adolescent And Youth Racial Stress In Marginalized Populations, Lauren B. Robins, Megan Cannedy, Rachel Kerrigan, Brittany G. Suggs

Counseling & Human Services Faculty Publications

Racial unrest recently has been incessant. In response, this conceptual contribution explores a prevention-based program for African American adolescents and youth to aid in their navigation through ubiquitous racial unrest and persistent mental health adversities. This article provides a comprehensive literature review on racial injustice and presents information regarding race-based traumatic stressors and adverse mental health outcomes. The prevention-based program that was created in response to the apparent racial unrest among African American youth and adolescents is presented and explored. The goal of this conceptual article is to raise awareness of this issue, provide practical steps to combat racial injustice, …

Developing An End-Of-Life Discussion Protocols, James Hawley

Rural Health Professions Projects

End of life (EOL) issues are far too often addressed reactively in Emergency Departments when patients can no longer express their wishes. This scenario can result in unwanted futile care, increased healthcare costs, and emotional hardships for family and healthcare workers. The purpose of this quality improvement project was to implement a provider-patient communication protocol that would shift advanced directive conversations proactively back into the local rural primary care setting.

Improving Ob Trauma Care Using A Standardized Protocol, Johanna Renee Ridley, Madeline Elaine Huff, Abaigeal Thompson

MEDI 9331 Scholarly Activities Clinical Years

Introduction

Timely evaluation of a pregnant woman experiencing trauma has significant implications. To optimize trauma care for obstetrical patients, our Level I Trauma Center at Doctors Hospital at Renaissance initiated a Standard Operating Procedure (SOP) which puts an OBGYN at bedside within 15 minutes of arrival. This involves calling an ‘OB Trauma Alert’ and arranging expedited travel to the center. We performed a quality improvement initiative to evaluate operational compliance.

Methods

The IRB deemed this project non-regulated research. Therefore, we reviewed obstetrical trauma admissions and subsequent deliveries of pregnant women >20 weeks presenting within 2 years before SOP implementation through …

Laypeople Perception And Interpretation Of Simulated Life-Threatening Bleeding: A Controlled Experimental Study, Erik Prytz, Rachel Phillips, Susanna Lönnqvist, Marc Friberg, Carl-Oscar Jonson

Psychology Faculty Publications

Introduction

First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations.

Method

A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate …

Prevalence And Correlates Of Sex Selling And Sex Purchasing Among Adults Seeking Treatment For Cocaine Use Disorder, Emma C Lathan, Judy H Hong, Angela M Heads, Nicholas C Borgogna, Joy M Schmitz

Faculty, Staff and Student Publications

Exchange sex places individuals with cocaine use disorder (CUD) at particularly high risk for deleterious safety and health outcomes. A substance use treatment provider who is aware of a patient's exchange sex behavior is better able to provide appropriate screening, care, and/or referral to risk reduction services. However, little is known about exchange sex, especially purchasing, among treatment-seeking adults with CUD. The current study examined the prevalence and correlates of sex selling and sex purchasing among treatment-seeking men and women with CUD (

A Preliminary Dti Tractography Study Of Developmental Neuroplasticity 5–15 Years After Early Childhood Traumatic Brain Injury, Elisabeth A Wilde, Ilirjana Hyseni, Hannah M Lindsey, Jessica Faber, James M Mchenry, Erin D Bigler, Brian D Biekman, Laura L Hollowell, Stephen R Mccauley, Jill V Hunter, Linda Ewing-Cobbs, Mary E Aitken, Marianne Macleod, Zili D Chu, Linda J Noble-Haeusslein, Harvey S Levin

Faculty, Staff and Student Publications

Plasticity is often implicated as a reparative mechanism when addressing structural and functional brain development in young children following traumatic brain injury (TBI); however, conventional imaging methods may not capture the complexities of post-trauma development. The present study examined the cingulum bundles and perforant pathways using diffusion tensor imaging (DTI) in 21 children and adolescents (ages 10-18 years) 5-15 years after sustaining early childhood TBI in comparison with 19 demographically-matched typically-developing children. Verbal memory and executive functioning were also evaluated and analyzed in relation to DTI metrics. Beyond the expected direction of quantitative DTI metrics in the TBI group, we …

As Time Goes By: Understanding Child And Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury, Linda Ewing-Cobbs, Janelle J Montroy, Amy E Clark, Richard Holubkov, Charles S Cox, Heather T Keenan

Faculty, Staff and Student Publications

Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.

Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from …

The Association Of Abo Blood Groups And Trauma Outcomes: A Retrospective Analysis Of 3779 Patients., Michael W Sauder, Timothy W Wolff, Aimee K Lariccia, M Chance Spalding, Urmil B Pandya

Trauma and Acute Care Articles

BACKGROUND: There is currently a lack of understanding regarding the link between ABO blood types with outcomes of traumatically injured patients. The purpose of this study was to determine the association of ABO blood types with outcomes in traumatically injured patients separated by injury type.

METHODS: This retrospective study evaluated trauma patients at an urban, Level 1 trauma center from January 1, 2017, through December 31, 2017. Patients were excluded if they were pregnant or < 16 years old. Recorded outcomes included: ABO blood group, mortality, Injury Severity Score (ISS), race, injury type, mechanism of injury, and complications. Data analysis was performed using descriptive statistics including Chi-squared, Kruskal-Wallis, and

RESULTS: A total of 3779 patients were included in this study. No significant differences were present in mean age or ISS between blood types. In …

Induction Of Hypothermia In Patients With Traumatic Brain Injury, Frank Hadden, Courtney Lennix

Physician Assistant Capstones, 2020-current

Common Abbreviations:

TBI = Traumatic Brain Injury

Glasgow Outcome Scale = GOS

Glasgow Outcome Scale Extended = GOSE

Objective: To determine whether hypothermia induction improves long-term morbidity and mortality in patients with severe traumatic brain injury

Methods: A search was conducted using PubMed database and the search terms “induced hypothermia” and “traumatic brain injury”. Studies were excluded if the publication dates were over 10 years old, children were the population being studied, and the researchers were looking at other independent variables.

Results: The results from all three randomized control trials showed that the induction of hypothermia did not show effectiveness …

Healthcare Utilization Patterns Among Children With A History Of Child Protective Services Investigations, Jill Mcleigh, Christian Carr, Heidi Roman, Jessica Fults, Jennifer Reingle Gonzalez, Corron Sanders, Michiko Otsuki Clutter, Ray Tsai, Katelyn Jetelina

Health Status, Outcomes, and Literacy and Healthcare Utilization

Examine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations.

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

childrens.com/fostercare

Change In The Spectrum Of Orthopedic Trauma: Effects Of Covid-19 Pandemic In A Developing Nation During The Upsurge; A Cross-Sectional Study, Pervaiz Mahmood Hashmi, Marij Zahid, Syed Arif Ali, Hammad Naqi Khan, Anum Sadruddin Pidani, Alizah Pervaiz Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The COVID-19 pandemic has caused a great impact on orthopedic surgery with a significant curtailment in elective surgeries which is the major bread and butter for orthopedic surgeons. It was also observed that the spectrum of orthopedic trauma injuries has shifted from more severe and frequent road traffic accidents (high energy trauma) to general, low energy house-hold injuries like low energy fractures in the elderly, pediatric fractures, house-hold sharp cut injuries and nail bed lacerations. The aim of this study is to appraise the effect of the COVID-19 pandemic on orthopedic surgical practice, both inpatient and outpatient facility.
Materials …

A Step In The Right Direction: Point-Of-Care Ultrasound As An Evaluation Tool Of Achilles Tendon Injuries In The Emergency Department., Chase A Silvers, Robert Lowe, Eric Cortez

Trauma and Acute Care Articles

This report describes the diagnosis of an Achilles tendon tear in a female patient with an inconclusive physical exam, which was limited by the patient's body habitus. Expedient use of point-of-care ultrasound supported the diagnosis of an Achilles tear with findings of a tendinous defect, fibrous stranding, and surrounding anechoic fluid, suggestive of localized hemorrhage. The patient was splinted in plantar flexion and had prompt orthopedic referral with MRI that verified Achilles tear.