Trauma Commons^™

Research Participation Of Minor Adolescents In Foster Care, Jenny Francis, Jane Andresen, Heidi Kloster, Jill Mcleigh, Alexis Guzman, Susan Rosenthal

Health Status, Outcomes, and Literacy and Healthcare Utilization

In this study we evaluated published studies about foster care to: (1) determine the types of data used; (2) describe the degree to which a sexual/reproductive health topic was addressed; and (3) describe the consent process.

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

childrens.com/fostercare

Cardiopulmonary Resuscitation (Cpr) Training Strategies In The Times Of Covid-19: A Systematic Literature Review Comparing Different Training Methodologies, Daniyal Mansoor Ali, Butool Hisam, Natasha Shaukat, Mirza Noor Ali Baig, Marcus Eng Hock Ong, Jonathan L. Epstein, Eric Goralnick, Paul D. Kivela, Bryan Mcnally, Junaid Razzak

Department of Emergency Medicine

Background: Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training.
Methods: We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts.
Results: Of the 978 …

Prior Sleep Problems And Adverse Post-Traumatic Neuropsychiatric Sequelae Of Motor Vehicle Collision In The Aurora Study, Thomas C Neylan, Ronald C Kessler, Kerry J Ressler, Gari Clifford, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Sarah D Linnstaedt, Laura T Germine, Sophia Sheikh, Alan B Storrow, Brittany E Punches, Kamran Mohiuddin, Nina T Gentile, Meghan E Mcgrath, Sanne J H Van Rooij, John P Haran, David A Peak, Robert M Domeier, Claire Pearson, Leon D Sanchez, Niels K Rathlev, William F Peacock, Steven E Bruce, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Steven E Harte, James M Elliott, Irving Hwang, Maria V Petukhova, Nancy A Sampson, Karestan C Koenen, Samuel A Mclean

Faculty, Staff and Students Publications

STUDY OBJECTIVES: Many patients in Emergency Departments (EDs) after motor vehicle collisions (MVCs) develop post-traumatic stress disorder (PTSD) or major depressive episode (MDE). This report from the AURORA study focuses on associations of pre-MVC sleep problems with these outcomes 8 weeks after MVC mediated through peritraumatic distress and dissociation and 2-week outcomes.

METHODS: A total of 666 AURORA patients completed self-report assessments in the ED and at 2 and 8 weeks after MVC. Peritraumatic distress, peritraumatic dissociation, and pre-MVC sleep characteristics (insomnia, nightmares, daytime sleepiness, and sleep duration in the 30 days before the MVC, trait sleep stress reactivity) were …

Incidence And Risk Factors Of Delirium In Surgical Intensive Care Unit, Muhammad Asghar Ali, Madiha Hashmi, Waqas Ahmed, Syed Amir Raza, Muhammad Faisal Khan, Bushra Salim

Department of Anaesthesia

Background: To evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.
Methods: We conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors. …

Angioembolisation For The Treatment Of Pseudo-Aneurysm Of Internal Maxillary Artery, Muhammad Azeemuddin, Anosha Khan, Atif Hafeez Siddiqui, Asad Shakil, Basit Salam, Raza Sayani

Department of Radiology

Pseudo-aneurysm of internal maxillary artery, following a road traffic accident, is a rare clinical scenario. The consequence of pseudo-aneurysm may be spontaneous rupture of the arterial wall, which may eventually lead to life-threatening hemorrhage. We report a case of a 20-year male who presented with recurrent epistaxis. CT scan was performed, which revealed a pseudo-aneurysm of the internal maxillary artery; this was successfully treated by angioembolisation. Similar cases of traumatic pseudo-aneurysms have been reported, however, none presented with recurrent epistaxis after management of pan-facial fractures. Key Words: Epistaxis, Pseudo-aneurysm, Angioembolisation, Pan-facial fracture.

Comparison And Interpretability Of Machine Learning Models To Predict Severity Of Chest Injury, Sujay Kulshrestha, Dmitriy Dligach, Cara Joyce, Richard Gonzalez, Ann P. O'Rourke, Joshua M. Glazer, Anne Stey, Jacqueline M. Kruser, Matthew M. Churpek, Majid Afshar

Biostatistics Collaborative Core: Faculty Publications and Other Works

Objective: Trauma quality improvement programs and registries improve care and outcomes for injured patients. Designated trauma centers calculate injury scores using dedicated trauma registrars; however, many injuries arrive at nontrauma centers, leaving a substantial amount of data uncaptured. We propose automated methods to identify severe chest injury using machine learning (ML) and natural language processing (NLP) methods from the electronic health record (EHR) for quality reporting.

Materials and Methods: A level I trauma center was queried for patients presenting after injury between 2014 and 2018. Prediction modeling was performed to classify severe chest injury using a reference dataset labeled by …

Trauma Recidivism In An Aging Population: Who Is Most At Risk?, Ryan Taylor, Austin Mccrea, Nayda Parisio Poldiak, Keely Muertos, Saptarshi Biswas, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

Repeated episodes of trauma, particularly in older adults, result in increased morbidity and mortality. This study investigates trauma recidivism in our adult population to identify which patients in our region are more likely to become recidivists.

Materials and Methods

This 4 year retrospective study (2013 to 2017) examines all patients 18 years of age or older with multiple hospital admissions for trauma, comparing patients ages 65 and older (older adults) to those ages 18 to 64 (younger adults). Exclusion criteria consisted of those younger than 18 and/or had a home zip code outside of the study region. Data included …

A Modern "Nightstick Fracture" Induced By Contemporary Ballistics During The George Floyd Protests., Braden J Passias, Benjamin C Taylor, Devon Myers, John Casey

Trauma and Acute Care Articles

A 28-year-old male presented to the emergency department with an isolated ulnar shaft fracture secondary to a ballistic injury with a wooden pellet gun. This injury is also known as a "nightstick fracture," which is a common eponym in orthopedic surgery used to describe a fracture of the ulnar shaft. The eponym gained its title for the injury commonly seen when in a defensive position while being attacked with a wooden club. It is widely accepted that this infamous injury was popularized in the 1960s as a sequela of the many race-related riots across the United States. This case details …

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) …

Links Between Thrombosis And Inflammation In Traumatic Brain Injury, W Brad Hubbard, Jing-Fei Dong, Miguel A Cruz, Rolando E Rumbaut

Faculty, Staff and Students Publications

Traumatic brain injury (TBI) continues to be a major healthcare problem and there is much to be explored regarding the secondary pathobiology to identify early predictive markers and new therapeutic targets. While documented changes in thrombosis and inflammation in major trauma have been well described, growing evidence suggests that isolated TBI also results in systemic alterations in these mechanisms. Here, we review recent experimental and clinical findings that demonstrate how blood-brain barrier dysfunction, systemic immune response, inflammation, platelet activation, and thrombosis contribute significantly to the pathogenesis of TBI. Despite advances in the links between thrombosis and inflammation, there is a …

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

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 …

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 …

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 …

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.