Trauma Commons^™

An Acute Hepatic Hydrothorax Causing Tension., Dina R Assali, Austin Richardson, Andrew Kalnow

Trauma and Acute Care Articles

Patients with advanced cirrhosis are at risk for numerous complications, including hepatic hydrothorax. Hepatic hydrothorax most commonly occurs in the right pleural space but less commonly can present on the left hemithorax. The exact pathophysiology is not fully understood, but there are several schools of thought for right-sided effusions. In this case report, we discuss the findings of a 76-year-old female who experienced a left-sided hydrothorax likely stemming from her underlying liver disease which created tension pathology in an otherwise stable patient. Interestingly, this accumulation occurred over a couple of weeks despite optimal medical management. A thoracentesis confirmed ascitic fluid. …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

The Impact Of Health Status On Health Care Utilization Of Children In Foster Care, Jill Mcleigh, Gunjan Singh, Rong Huang

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

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

childrens.com/fostercare

The Psychometric Properties Of The Swahili Version Of The Primary Care Post Traumatic Stress Disorder Screen For Dsm-5 Among Adults In Kenya, Patrick Nzivo Mwangala, Joseph Newton Guni, Paul Mwangi, Millicent Makandi, Anita Kerubo, Rachel Odhiambo, Amina Abubakar

Institute for Educational Development, East Africa

Background: The psychometric properties of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) are undocumented in Kenya and sub-Saharan Africa (SSA) at large. This study aimed to evaluate the psychometric properties of the Swahili version of the tool, S-PC-PTSD-5, in a community sample of adults 18 years and older drawn from Nairobi, Mombasa and Kwale counties in Kenya.

Methods: Analysis of cross-sectional data from 1431 adults from the community was conducted, examining the reliability, factorial structure, measurement invariance, and convergent and divergent validity of the interviewer-administered S-PC-PTSD-5.

Results: Out of 1431 adults who completed the S-PC-PTSD-5, 666 (46.5%) reported experiencing …

Rare Right-Sided Posterolateral Diaphragmatic Hernia In An Adult Presenting As An Incarcerated Large Bowel Obstruction: A Case Report, Tanya J. T. Starr, Andrew G. Nicholson, Maximillian J. H. Starr, Jessica A. Traxler, Peter Y. Chu

HCA Healthcare Journal of Medicine

Introduction

A diaphragmatic hernia (DH) is a defect within a part of the diaphragm that allows intra-abdominal contents to enter the thoracic cavity. Diaphragmatic hernias can be congenital or acquired later in life. The most common congenital DH is the Bochdalek hernia (posterolateral hernia), but the most commonly acquired DH is due to traumatic injury. These hernias are rare in adults and are typically diagnosed incidentally. Surgical repair is the standard of care; however, data regarding the surgical approach is scarce. We report a case of a rare right posterolateral DH in an adult female patient who presented with acute …

Team-Centered Care After Trauma Patient Death: Promoting Healers’ Healing By Humanizing Our Roles, Sydni Au Hoy, Carlie J. Arbaugh, Caitlin P. Bungo, Amanda J. Deutsch, Bonnie E. Chow, Kristen Gallegos, Nerissa Alansalon, Emmanuel Jisrawi, Al’Ai Alvarez, Brooke Gurland, Joseph Forrester

Journal of Wellness

Introduction: Recurrent exposures to adverse patient events, including death, affect all members of the care team and can have long-term effects on clinician performance, personal well-being, and patient safety. Recognizing the impact of patient deaths on care teams is essential to mitigating potential risks of increased clinician burnout. We share the outcomes of a three-month pilot wellness intervention implemented at a busy academic hospital, directed explicitly toward resuscitation care teams managing patients who die from traumatic injuries.

Approach: A collaborative group from Stanford’s Trauma Surgery, Emergency Department (ED), and well-being leadership developed an integrated workflow to connect with …

Relationships Between Trauma Types And Psychotic Symptoms: A Network Analysis Of Patients With Psychotic Disorders In A Large, Multi-Country Study In East Africa, Anne Stevenson, Supriya Misra, Engida Girma, Adela-Maria Isvoranu, Dickens Akena, Melkam Alemayehu, Lukoye Atwoli, Bizu Gelaye, Stella Gichuru, Symon Kariuki

Internal Medicine, East Africa

Background: The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. Methods: We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific …

African American Patients Have A Higher Probability Of Cognitive Impairment After Incident Stroke: An Analysis Of National Electronic Health Record Data, Alicia Zha, Chenguang Zhang, Gen Zhu, Xinran Huang, Sahar Anjum, Yashar Talebi, Sean Savitz, Hulin Wu

Faculty, Staff and Student Publications

Background: Cognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15-70 % but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race.

Methods: This is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009-2018. We …

Bayesian Varying-Effects Vector Autoregressive Models For Inference Of Brain Connectivity Networks And Covariate Effects In Pediatric Traumatic Brain Injury, Yangfan Ren, Nathan Osborne, Christine B Peterson, Dana M Demaster, Linda Ewing-Cobbs, Marina Vannucci

Faculty, Staff and Student Publications

In this article, we develop an analytical approach for estimating brain connectivity networks that accounts for subject heterogeneity. More specifically, we consider a novel extension of a multi-subject Bayesian vector autoregressive model that estimates group-specific directed brain connectivity networks and accounts for the effects of covariates on the network edges. We adopt a flexible approach, allowing for (possibly) nonlinear effects of the covariates on edge strength via a novel Bayesian nonparametric prior that employs a weighted mixture of Gaussian processes. For posterior inference, we achieve computational scalability by implementing a variational Bayes scheme. Our approach enables simultaneous estimation of group-specific …

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 …