Trauma Care

(1) Background: Patients who experience acute traumatic injury requiring hospitalisation represent a vulnerable population. The trauma patient often experiences multi-system injuries and complex physiology. Additionally, there are complex socio-ecological issues that impact the care and outcomes of trauma patients. Of interest, culturally and linguistically diverse populations with language barriers experience worse outcomes in trauma settings. This scoping review evaluates the current evidence on language barriers in this population and the influences on outcomes for trauma patients. (2) Methods: A scoping review was performed following a computer-assisted search of the Medline, Embase and Cochrane Central databases. Papers that evaluated the impact of the language barrier in culturally and linguistically diverse populations and outcomes in acute trauma settings were included. (3) Results: A literature search identified eight articles that were eligible for inclusion. Overall, there was no robust evidence to suggest that such populations were disadvantaged in terms of length of hospital stay and overall mortality. However, studies did identify that these populations were at higher risk of disability and poor mental health outcomes, experienced communication barriers more often and had lower social functioning. (4) Conclusions: This scoping review demonstrates that individuals admitted due to trauma who are from culturally and linguistically diverse backgrounds experience more significant disadvantages concerning psychological and functional outcomes. It is posited this is due to their inability to communicate their complex needs in trauma, however more robust and rigorous research is required to better characterise this effect. Full article

Antibiotic prophylaxis for extremity gunshot wounds (GSWs) is highly variable. The objective of the present study is to quantify the adherence rate to a protocol for single-dose cephalosporin prophylaxis for extremity GSWs and the impacts on post-injury infection rates. We reviewed patients presenting to a level 1 trauma center with an extremity gunshot wound between 2019 and 2021. Infection rates were compared for patients following the protocol or not, and for patients presenting before or after the protocol’s implementation. Overall, 94% of patients received antibiotic treatment at presentation, but only 34% followed the single-dose antibiotic protocol. The rate of protocol adherence increased from 15% to 39% after the protocol was implemented in the hospital in January 2020 (p = 0.081). Infection rates were not different before and after the protocol implementation (25% vs. 18%, p = 0.45). Infection rates were also not different between patients who did and did not follow the protocol (15% vs. 20%, p = 0.52). The implementation of a single-dose cephalosporin protocol increased adherence to the protocol in a level 1 trauma center without increasing infection rates. These findings support conservative treatment along with a single dose of first-generation cephalosporin antibiotic for uncomplicated extremity GSWs in order to decrease healthcare costs without compromising infection risk. Full article

Posttraumatic stress disorder (PTSD) is associated with functional impairment and poor quality of life (QoL) across multiple domains, such as social functioning, occupational and educational attainment, physical health, and overall life satisfaction and wellbeing. Yet, there is limited evidence for which PTSD symptom clusters may be more strongly associated with functional impairment and decreased QoL. We used a seven-factor model of PTSD (re-experiencing, avoidance, negative alterations, anhedonia, externalizing, dysphoric arousal, and anxious arousal) to predict QoL using a latent regression model in a sample (N = 537) of adult patients participating in exposure-based PTSD partial hospitalization programs (PHP). QoL was measured by the Quality-of-Life Satisfaction Questionnaire—Short Form (Q-LES-Q-SF). Among posttraumatic symptoms, anhedonia emerged as the only significant predictor in the model (β = −8.60, SE = 3.02, p = 0.004), when controlling for depression scores. The overall model accounted for 40% of the variance in QoL. Depression was also significantly associated with QoL (β = −1.67, SE = 0.15, p < 0.001), controlling for PTSD symptoms. Our findings are congruent with prior research supporting the role of anhedonia and emotional numbing in functional impairment, yet differ in that other factors of PTSD (e.g., re-experiencing, avoidance, negative alterations) were not significant. Understanding which PTSD symptom clusters are more strongly associated with QoL may inform treatment approaches or allow clinicians to tailor treatments. We discuss implications for treatment and future research. Full article

Over 50% of the 21 million veterans in the U.S. with behavioral health challenges are not having their needs met due to stigma and other barriers to care. Resiliency-based models focused on strengthening protective factors to help individuals adapt to adversity in community-based settings, that can be delivered by trained lay persons, are emerging approaches to help address this issue. This longitudinal pilot study evaluated the impact of one such evidenced-based intervention, the Community Resiliency Model (CRM), on veterans’ behavioral health and daily functioning. A sample of 46 English-speaking, ethnically diverse veterans were recruited for this study. Repeated measure analyses showed that CRM skills significantly decreased distress and increased well-being. We also found strong short-term results for measures of daily functioning with a significant longer-term impact on participants’ ability to control their feelings of being ‘amped up’. Most (82%) participants maintained and continued to use the CRM skills daily to weekly and had very positive reactions to the program. Across our analyses, the results of this pilot study suggest that providing CRM trainings to veterans is a feasible, efficacious, and well-received approach to help address much-needed veteran behavioral health. Full article

(1) Background: Immigrant families in the U.S. face a myriad of migration-related stressors and trauma, and legal vulnerability can further compound such stressors, influencing both immigrant caregiver and child wellbeing. This study explored the relationships between legal vulnerability, trauma, and migration and their effects on caregiving, psychological distress, and resilience in immigrant families. (2) Methods: In total, 37 Latinx immigrant caregiver–child dyads from a community sample were interviewed and completed self-report measures on their experiences of migration, trauma, psychological functioning, and parent–child relationships. (3) Results: Using a community-based, sequential quantitative-qualitative design, person-centered analyses revealed two caregiver clusters: “Personalizing Stress” and “Meaning-making”. Exemplar case analyses characterized differences between clusters, particularly related to trauma symptoms, in which the “meaning-making” cluster endorsed higher levels of psychological functioning and wellbeing compared to the “personalizing stress” cluster, in which the process of creating meaning from adversity appeared to function as a resilience resource for the “meaning-making” cluster. While most indicators of caregiver–child wellbeing were not correlated, family legal vulnerability was strongly correlated with high resilience in children. (4) Conclusions: Clinicians should attend to the resilience resources that immigrant families from legally vulnerable communities utilize, including meaning-making. Full article

The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n = 378) and after (n = 499) 1 April 2020 when Georgia’s COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s t-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (n = 328) or lack of mobilization (n = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s t-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective. Full article

In this narrative review, we explore the evolving role of machine learning (ML) in the diagnosis, prognosis, and clinical management of traumatic brain injury (TBI). The increasing prevalence of TBI necessitates advanced techniques for timely and accurate diagnosis, and ML offers promising tools to meet this challenge. Current research predominantly focuses on integrating clinical data, patient demographics, lab results, and imaging findings, but there remains a gap in fully harnessing the potential of image features. While advancements have been made in areas such as subdural hematoma segmentation and prognosis prediction, the translation of these techniques into clinical practice is still in its infancy. This is further compounded by challenges related to data privacy, clinician trust, and the interoperability of various health systems. Despite these hurdles, FDA-approved ML applications for TBI and their subsequent promising results underscore the potential of ML in revolutionizing TBI care. This review concludes by emphasizing the importance of bridging the gap between theoretical research and real-world clinical application and the necessity of addressing the ethical and privacy implications of integrating ML into healthcare. Full article

This was a novel pilot study about the relationship between PTSD severity and resource gain and loss using the conservation of resources (COR) model with U.S. Veterans. Higher PTSD severity was predicted to be associated with greater resource loss scores, and lower PTSD scores were predicted to be associated with greater resource gain scores. The sample size was limited (N = 19) due to the COVID-19 outbreak. Veterans completed a demographic questionnaire, the Montreal Cognitive Assessment (MoCA), the Combat Exposure Scale (CES), the PTSD Symptom Scale–Interview (PSS-I), the Conservation of Resources–Evaluation (COR-E), and two additional open-ended questions. A statistically significant negative medium effect size was found between PTSD diagnosis and resource gain (r(17) = −0.42, p = 0.039, one-tailed). A large effect size in resource gain scores between PTSD and non-PTSD groups was also found (t(17) = 1.880, p = 0.077, d = 0.87), with the non-PTSD group reporting more gain of resources than the PTSD group. Post hoc tests revealed that the resource gain score of the mild PTSD group was significantly higher than that of the severe + very severe PTSD group (p = 0.034). Results suggest that resource gain, when compared to resource loss, was the strongest predictor for a non-PTSD diagnosis. Full article

Objective: Active-duty military personnel in the current wars have experienced unique stressors that deviate from standard PTSD assessment and diagnosis. This situation calls for a refinement of military-related PTSD assessment. To this end, this study assessed the utility of the Trauma Symptom Inventory (TSI) in diagnosing PTSD among active-duty military personnel. The past literature has validated the TSI using populations with a small sample size. Hence, this study aimed to fill the gap by using a large sample size of 670 military members to examine whether the TSI is useful for military populations. Setting: Participants were referred to Carolina Psychological Health Services, in Jacksonville, North Carolina by military neurologists and other qualified medical officers from the Naval Hospital in Camp Lejeune, a military base located in Jacksonville, NC, for neuropsychological evaluation due to reported cognitive deficits related to military deployment (i.e., head injury due to exposure to blast injuries). Participants: Based on clinical diagnosis, comprehensive neuropsychological testing, and self-reported data, personnel were classified into four groups: blast exposure (n = 157), PTSD diagnosis (n = 90), both blast exposure and PTSD (n = 283), and neither blast exposure nor PTSD (n = 140), which helps provide a comprehensive picture of the utility of the TSI. Results: The TSI’s 10 clinical scales could distinguish between all groups. Discriminant function analysis showed that an optimally weighted combination of scales correctly predicted 66.67% of PTSD-positive cases and 35.11% of PTSD-negative cases. Conclusion: These findings provide support for the use of the TSI in the assessment of PTSD in active-duty military personnel. Due to the release of TSI-2, there is a need to replicate this data. However, the validity data has indicated a high concordance between the TSI and TSI-2, bolstering confidence in the current findings of the study. Full article

In high-income nations, gender has been associated with injury characteristics. This study evaluated injury epidemiology and care based on gender at the Centre Hospitalier Universitaire de Kigali in Rwanda. Patients presenting to the emergency department with acute injuries were prospectively enrolled from 27 January–28 June 2020, and descriptive statistics were performed with comparisons between males and females. Of 601 patients, 25.6% were female and 74.4% were male. There were gender differences in the mechanism of injury, with females more likely to be injured in falls (43.5% versus 23.0%, p = 0.001); meanwhile, males were more likely to suffer road traffic accidents (52.6% versus 39.6%, p = 0.006). The severity of injury was similar between genders based on the mean Kampala Trauma Score (14.4 versus 14.7, p = 0.09). Females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p = 0.001), and less likely to receive acute treatment during the first six hours of care (67.5% versus 78.1%, p = 0.009). There was no significant difference in mortality between females and males (2.0% versus 1.3%, p = 0.568). This study highlights differences in the epidemiology and care between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and developments in gender-centered healthcare delivery. Full article

Decades of research have enhanced our understanding of the psychological impact of sexual victimization, including risk factors through which post-traumatic stress disorder (PTSD) manifests. Research on sexual assault and PTSD predominately reflects the experience of heterosexual women, yet sexual minorities are both at increased risk of sexual assault and suffer greater negative health outcomes from it. In these cases, PTSD is linked to a clearly identifiable cause, thereby making it possible to identify individuals at risk, enhance interventions immediately following the traumatic event, and offer services to mitigate further harm. This narrative review explores the potential risk factors for PTSS and PTSD among individuals who experience sexual assault and identify as a sexual minority. Knowledge of these compounding risk factors among service providers will assist in obtaining sexual assault disclosures in a sensitive and supportive manner, leading to the provision of early interventions to mitigate the risks of developing PTSD following sexual assault. The findings suggest that empirical investigation is urgently required to develop evidence-informed practices in providing targeted interventions for sexual and gender minorities following a sexual assault and mitigating further adverse health outcomes. Full article

The aim of this study is three-fold: (1) to explore multiple community member views of core elements of trauma-responsive practice at a specialist school; (2) to explore impact on student wellbeing and learning outcomes, and educator experiences of their workplace; and (3) to explore insights into implementation challenges and enablers. This study uniquely incorporates four participant cohorts: parents or caregivers, educators, and community agencies involved with school students and their families. It utilises a mixed-methods approach with an emphasis on the voice of participants and their lived experience of a trauma-responsive specialist school. The data identify a trauma-responsive school culture, high staff satisfaction, improved student wellbeing and attendance, and progress towards learning goals. Reflective analytic themes centre on a collective experience of the school as a connected community, emphasising relationships, safety, collaboration, mutuality, voice, and empowerment. Findings show that the practices most valued across the cohorts centre on the collective experience of the school as a connected community, emphasising relationships, safety, deep listening, collaboration, mutuality, voice, and empowerment. Trauma-informed principles frame the discussion and implications for equity-focused trauma-responsive practice and policy development. Implications for practice and policy development are discussed. Full article

Purpose: Early loss of reduction remains a challenging complication in distal radius fracture management. There are limited data on factors that correlate with early loss of reduction. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification has become a popular way of evaluating complex fracture patterns. This study aims to determine the impact of fracture pattern, as determined by the AO classification, on restoration of intraoperative parameters, early loss of reduction, and time to fracture union in operatively treated distal radius fractures. Methods: Following IRB approval, adult patients with surgically treated acute distal radius fractures at a single level I institution were identified. Retrospective chart and radiographic review were used to obtain AO classification, postoperative radiographic parameters, early loss of reduction, time to fracture union, as well as any complications. Results: 422 patients with operatively treated distal radius fractures were included in this study. Across fracture patterns, there were no significant differences in restoration of radial height or inclination. Higher severity fracture classifications had decreased restoration of volar tilt. Overall, simple fractures (A2, C1) and partial articular fractures (B1, B2, B3) had higher rates of satisfactory alignment restoration compared to comminuted fractures (A3, C2, C3). Although there were differences in restoration of radiographic parameters, fracture type did not correlate with loss of reduction within 30 days. C type fractures correlated with increased weeks to radiographic healing. Conclusions: This study establishes that distal radius fracture pattern, as determined by the AO classification, has a significant impact on intraoperative restoration of parameters but does not correlate with early loss of reduction. Furthermore, more difficult fracture patterns may have a longer time to fracture union, but fracture type does not appear to have an effect on postoperative complications. Full article

Introduction: Personal, behavioral, and environmental risk factors are correlated to varying degrees with each other and with the overall likelihood of violent reinjury. When used with fidelity, risk assessment instruments, including the violence reinjury risk assessment instrument (VRRAI), identify domains in which individuals present elevated risk levels to aid in matching services with needs. Less is known about the collinearity among risk factors for violently injured individuals admitted to hospitals. Collinearity between risk factors has ramifications for predictive modeling of violent reinjury risk. The objective of this study was to identify significantly correlated risk factors when the VRRAI was used by hospital-based violence intervention programs (HVIP) for clients. Materials and Methods: Victims of violent injury by modality of firearm, stabbing, and physical assault who were admitted to a level 1 trauma center at a single institution were voluntarily enrolled in a hospital-based violence intervention program (HVIP) between September 2020 and June 2022. Violence intervention specialists (VIS) completed the VRRAI within the first month of participant enrollment. The VRRAI is comprised of 29 binary indicators that may signal elevated risk of violent reinjury. Data from completed assessments were used to apply risk-need-responsivity (RNR) principles along with phi coefficients of key indicators to examine overlap and prevalence in the population. Results: A total of 98 participants were enrolled in the HVIP. The median age was 27 years old and 79 (80.6%) were male, while 66 (67.3%) were non-Hispanic Black or African American, 9 (9.2%) were non-Hispanic White, and 17 (17.3%) identified as Hispanic or Latino. Several statistically significant relationships existed between key risk indicators in the VRRAI. Importantly, a robust relationship was found between the two dynamic risk factors of having heavy connection with gangs and a perception of imminent threat of violence (φc = 0.57, p < 0.01). Conclusion: Data suggest that some variables could be consolidated or removed from the VRRAI to create an even shorter instrument that can be performed more rapidly in the clinical setting. The application of the RNR model illustrates a limited number of dynamic risk factors that could be immediately addressed as part of case management should be prioritized among the questions selected from the VRRAI for inquiry at the intake assessment. Full article

Since 1995, it has been known that carbohydrate drinks (CHDs) can be safely consumed two to three hours (2–3 h) preoperatively. Furthermore, preoperative CHDs significantly benefit many outcomes, such as thirst, hunger, and insulin resistance. Patients, however, still fast excessively. This study aimed to determine if a CHD, consumed 2–3 h preoperatively, impacts postoperative inflammation compared to a placebo drink or fasting. This was achieved through analysing the levels of interleukin-6, C-reactive peptide, and serum albumin 10–24 h postoperatively. We conducted a systematic review of randomised control trials. We comprehensively searched the Embase, MEDLINE and Web of Science databases, identified 473 studies, and, after screening, were left with 10 randomised control trials. Our meta-analyses found a significantly lower mean interleukin-6 level of −21.26 pg/mL ((95% CI −33.37, −9.15); p = 0.0006) postoperatively in patients given a preoperative CHD compared to fasting and a significantly higher mean serum albumin level of 2.56 g/L ((95% CI 1.41, 3.71); p < 0.0001) postoperatively in patients given a preoperative CHD compared to a placebo. Our results therefore show that a CHD, consumed 2–3 h preoperatively, lowers proinflammatory cytokine levels and increases serum albumin levels. Thus, our study reinforces guideline recommendations to give patients a CHD 2–3 h preoperatively for improved outcomes. Full article

The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD. Full article

There is some evidence that autistic children experience more traumatic events than non-autistic children, but little research attention has been given to sex differences on this issue. This study investigated the presence of sex-based differences in the occurrence and severity of trauma-related events and resultant stress in autistic youth, and tested the null hypothesis of no sex differences. A sample of 32 autistic males and 32 autistic females (6 yr to 18 yr), plus one of their parents, participated in a survey study of (a) the presence of a traumatic event and ongoing stress regarding that event, and (b) recurrent memories or dreams of that event. Although the autistic children rated their experience of trauma, plus their recurrent memories or dreams of that event, as more severe than their parents did, neither of these sources of information showed any significant sex differences in the total score or diagnostic frequency for trauma-related stress. There were no significant correlations between age, IQ, or autism severity and trauma-related stress scores for the autistic males or females. These results challenge the generalizability of the prevalence of sex differences in trauma-related stress that has been reported in the wider community, arguing that equal attention should be given to male and female autistic youth for this possible comorbidity. Full article

Sex disparities in access and quality of care are well known for some time-sensitive conditions. However, the impact of sex on early trauma care remains unknown. In this study, we compared delays of completion of life-saving interventions (LSIs) between females and males among severely injured patients. This is a retrospective cohort study of all patients who consulted or were transported by ambulance in the emergency department (ED) of a level-one trauma centre following injury between September 2017 and December 2019 and for whom at least one LSI was performed. The list of LSIs was established by an expert consensus and included trauma team leader (TTL) activation, endotracheal intubation, chest decompression, blood transfusion, massive transfusion protocol, neurosurgery, spinal surgery, intestinal surgery, and spleen, liver and/or kidney angiography. A total of 905 patients were included. No significant statistical differences in the LSI delays were found when comparing females and males brought directly to the ED and transferred from another health care setting. Results of this study suggest that delays before completion of LSIs are similar for severely injured patients at our major trauma centre regardless of their sex. Full article

Infidelity, a betrayal within a romantic partnership, often violates a person’s core beliefs about themselves and their significant other and can influence the degree to which a person can feel safe in romantic relationships. Infidelity can also increase exposure to sexually transmitted diseases that can compromise physical and mental health. Therefore, infidelity can be judged as central to one’s identity and potentially traumatic, possibly triggering outcomes similar to other DSM-5 Criterion A traumas. The current research examines the contribution of centrality perceptions to the development of PTG and PTS post-infidelity. Bivariate regressions examined the relationships between the judged centrality of infidelity and PTG and PTS, respectively. Exploratory analyses considered the moderating role of relationship form (i.e., casually dating, exclusively dating, and engaged/married) on those relationships. In a sample of 177 adults, greater judgments of the centrality of infidelity were associated with both PTG and PTS. Results demonstrated a significant moderating effect of relationship form on the relationship between the centrality of infidelity and PTG but not between the centrality of infidelity and PTS. Moderation results demonstrated that if infidelity is considered central in a casually dating relationship, it is more strongly related to PTG than in other relationship forms. Considering infidelity as central may generate both beneficial and problematic post-traumatic outcomes. However, an early infidelity experience may provide increased opportunities for engagement in different behaviors in the future (e.g., selecting a different partner, setting different relational boundaries), which, in turn, may be more conducive to growth. Full article