Major Trauma Hospitals Research Articles

Epidemiology of Foot and Ankle Fractures in the United States: An Analysis of the National Trauma Data Bank (2007 to 2011)

Understanding the epidemiology of foot and ankle trauma could be useful in health services research and for policy makers. It can also define practice patterns. Using the National Trauma Data Bank data set from 2007 to 2011, we analyzed the frequency and proportion of each fracture in the foot and ankle in major trauma hospitals in the United States. A total of 280,933 foot and/or ankle fractures or dislocations were identified. Although oversampling of more severe trauma in younger patients might have occurred owing to the nature of the data set, we found that the most common fractures in the foot and ankle were ankle fractures. Midfoot fractures were the least common among all the foot and ankle fractures when categorized by anatomic location. Approximately 20% of all foot and ankle fractures were open.

Decompressive craniectomy for severe traumatic brain injury: The relationship between surgical complications and the prediction of an unfavourable outcome

ObjectTo assess the impact that injury severity has on complications in patients who have had a decompressive craniectomy for severe traumatic brain injury (TBI). MethodsThis prospective observational cohort study included all patients who underwent a decompressive craniectomy following severe TBI at the two major trauma hospitals in Western Australia from 2004 to 2012. All complications were recorded during this period. The clinical and radiological data of the patients on initial presentation were entered into a web-based model prognostic model, the CRASH (Corticosteroid Randomization After Significant Head injury) collaborators prediction model, to obtain the predicted risk of an unfavourable outcome which was used as a measure of injury severity. ResultsComplications after decompressive craniectomy for severe TBI were common. The predicted risk of unfavourable outcome was strongly associated with the development of neurological complications such as herniation of the brain outside the skull bone defects (median predicted risk of unfavourable outcome for herniation 72% vs. 57% without herniation, p=0.001), subdural effusion (median predicted risk of unfavourable outcome 67% with an effusion vs. 57% for those without an effusion, p=0.03), hydrocephalus requiring ventriculo-peritoneal shunt (median predicted risk of unfavourable outcome 86% for those with hydrocephalus vs. 59% for those without hydrocephalus, p=0.001), but not infection (p=0.251) or resorption of bone flap (p=0.697) and seizures (0.987). We did not observe any associations between timing of cranioplasty and risk of infection or resorption of bone flap after cranioplasty. ConclusionsMechanical complications after decompressive craniectomy including herniation of the brain outside the skull bone defects, subdural effusion, and hydrocephalus requiring ventriculo-peritoneal shunt were more common in patients with a more severe form of TBI when quantified by the CRASH predicted risk of unfavourable outcome. The CRASH predicted risk of unfavourable outcome represents a useful baseline characteristic of patients in observational and interventional trials involving patients with severe TBI requiring decompressive craniectomy.

Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a randomised clinical trial

BackgroundDistal radius fractures are among the most common fractures seen in the hospital emergency department. Of these, over 40% are considered unstable and require some form of fixation. In recent years with the advent of low profile plating, open reduction and internal fixation (ORIF) using volar plates has become the surgical treatment of choice in many hospitals. However, it is currently unknown which plating system has the lowest complication rate and/or superior clinical and radiological outcomes following surgery. Few studies have compared different types of plates, which may have various features, different plate and screw designs or may be manufactured from different materials (for example, stainless steel or titanium). This study will specifically investigate and compare the clinical and radiological outcomes and complication rates of two commonly used volar plating systems for fixation of distal radius fractures: one made from stainless steel (Trimed™ Volar Plate, Trimed™, California, USA) and the other made from titanium (Medartis® Aptus Volar Plate, Medartis®, Basel, Switzerland). The primary aim of this study is to determine if there is a difference on the Patient Reported Wrist Evaluation six months following ORIF using a volar plate for adult patients with a distal radius fracture.Methods/DesignThis study will implement a randomized prospective clinical trial study design evaluating the outcomes of two different types of volar plates: one plate manufactured from stainless steel (Trimed™ Volar Plate) and one plate manufactured from titanium (Medartis® Aptus Volar Plate). The surgery will be performed at a major trauma hospital in Brisbane, Australia. Outcome measures including function, adverse events, range of movement, strength, disability, radiological findings and health-related quality of life will be collected at 6 weeks, 3, 6, 12 and 24 months following surgery. A parallel economic analysis will also be performed. This randomized clinical trial is due to deliver results in December 2016.DiscussionResults from this trial will contribute to the evidence on operative management of distal radius fractures and plate material type.Trial registrationACTRN12612000969864

Validation of the CRASH model in the prediction of 18-month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy

The goal in this study was to assess the validity of the corticosteroid randomization after significant head injury (CRASH) collaborators prediction model in predicting mortality and unfavorable outcome at 18 months in patients with severe traumatic brain injury (TBI) requiring decompressive craniectomy. In addition, the authors aimed to assess whether this model was well calibrated in predicting outcome across a wide spectrum of severity of TBI requiring decompressive craniectomy. This prospective observational cohort study included all patients who underwent a decompressive craniectomy following severe TBI at the two major trauma hospitals in Western Australia between 2004 and 2012 and for whom 18-month follow-up data were available. Clinical and radiological data on initial presentation were entered into the Web-based model and the predicted outcome was compared with the observed outcome. In validating the CRASH model, the authors used area under the receiver operating characteristic curve to assess the ability of the CRASH model to differentiate between favorable and unfavorable outcomes. The ability of the CRASH 6-month unfavorable prediction model to differentiate between unfavorable and favorable outcomes at 18 months after decompressive craniectomy was good (area under the receiver operating characteristic curve 0.85, 95% CI 0.80-0.90). However, the model's calibration was not perfect. The slope and the intercept of the calibration curve were 1.66 (SE 0.21) and -1.11 (SE 0.14), respectively, suggesting that the predicted risks of unfavorable outcomes were not sufficiently extreme or different across different risk strata and were systematically too high (or overly pessimistic), respectively. The CRASH collaborators prediction model can be used as a surrogate index of injury severity to stratify patients according to injury severity. However, clinical decisions should not be based solely on the predicted risks derived from the model, because the number of patients in each predicted risk stratum was still relatively small and hence the results were relatively imprecise. Notwithstanding these limitations, the model may add to a clinician's ability to have better-informed conversations with colleagues and patients' relatives about prognosis.

A prospective study of rapid breathing and the development of posttraumatic panic disorder.

This study tested the theory that rapid breathing at the time of a traumatic event leads to development of panic disorder (PD). Traumatically injured patients (n = 1,061) from 4 major trauma hospitals had their respiratory rates (RR) assessed at the scene of traumatic injury, subsequently assessed for lifetime PD, and reassessed 3 months later for PD (n = 843). At follow-up, 59 (7%) patients met criteria for new-onset PD. Patients with elevated RR (>21 breaths per minute) were more likely to meet criteria for PD than those without elevated RR (34% vs. 19%). PD diagnosis at 3 months was significantly predicted by elevated RR after controlling for gender, age, trauma type, injury severity, and fear at the time of the event (p = .03). Participants with elevated RR were 1.79 times more likely to develop PD than those with lower RR. These data suggest that rapid breathing at the time of a traumatic event may be associated with subsequent PD development. (PsycINFO Database Record © 2014 APA, all rights reserved).

Needs and experiences of intensive care patients' families: a Saudi qualitative study

To identify the perceived needs of Saudi families of patients in Intensive Care in relation to their culture and religion. Admission of a family member to an intensive care unit (ICU) is a deeply distressing and often unexpected life event to the family. Families of critically ill patients have needs that should be acknowledged and met by the ICU team. Literature is virtually silent on the issue of recognizing the ICU family needs in relation to the influence of their cultural values and religious beliefs. A descriptive exploratory qualitative study. Individual, semi-structured interviews of a purposive sample of 12 family members were carried out between November 2011 and February 2012. The closest family members were recruited to participate in the interviews with a mean age of 44·25 years in eight mixed medical-surgical ICUs of eight major trauma hospitals in Saudi Arabia. The family needs and experiences are described via six major themes: looking for information, maintaining reassurance, spiritual healing, maintaining close proximity, involvement in care and support not being facilitated. The results indicated that family members sought to access information readily to diminish their anxiety. They also needed to be reassured that the best care was being delivered to their loved one and to feel supported during this critical time. Saudi families have cultural and spiritual healing beliefs and practices including faith in God and that God is the ultimate healer, reading of the Qur'an, prayer and charity. These lessen their stress and connect them to hold on to hope. In addition, maintaining proximity to their ill family member was considered of the greatest importance to the families. The study provided an in-depth understanding of the family members' experience of having a relative in Intensive Care and focussed on a range of unmet needs, particularly those related to culture and religion. The ICU team need to work collaboratively with family members to improve their experience. The recognition of family needs, experiences and situations can enhance the care provided by the critical care team to patients and families.

A Multisite Analysis of the Fluctuating Course of Posttraumatic Stress Disorder

Delayed-onset posttraumatic stress disorder (PTSD) accounts for approximately 25% of PTSD cases. Current models do not adequately explain the delayed increases in PTSD symptoms after trauma exposure. To test the roles of initial psychiatric reactions, mild traumatic brain injury (MTBI), and ongoing stressors on delayed-onset PTSD. In this prospective cohort study, patients were selected from recent admissions to 4 major trauma hospitals across Australia. A total of 1084 traumatically injured patients were assessed during hospital admission from April 1, 2004, through February 28, 2006, and 785 (72.4%) were followed up at 3, 12, and 24 months after injury. Severity of PTSD was determined at each assessment with the Clinician-Administered PTSD Scale. Of those who met PTSD criteria at 24 months, 44.1% reported no PTSD at 3 months and 55.9% had subsyndromal or full PTSD. In those who displayed subsyndromal or full PTSD at 3 months, PTSD severity at 24 months was predicted by prior psychiatric disorder, initial PTSD symptom severity, and type of injury. In those who displayed no PTSD at 3 months, PTSD severity at 24 months was predicted by initial PTSD symptom severity, MTBI, length of hospitalization, and the number of stressful events experienced between 3 and 24 months. These data highlight the complex trajectories of PTSD symptoms over time. This study also points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity. This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms, particularly in those with no acute symptoms.

How “Successful” Is Calvarial Reconstruction Using Frozen Autologous Bone?

The authors investigated the long-term outcome of frozen autologous bone cranioplasty in patients who had undergone decompressive craniectomy for severe traumatic brain injury. A retrospective analysis was undertaken of all patients who had undergone decompressive craniectomy at the two major trauma hospitals in Western Australia between 2004 and 2010. A specific note was made regarding "failure" of frozen autologous bone because of either infection or bone flap resorption. A total of 194 patients required either unilateral or bilateral decompressive craniectomy for severe traumatic brain injury during the study period. Of these patients, 156 had had an autologous cranioplasty. Among these patients, the cranioplasty was judged a failure in 45 (29 percent). Thirteen (8.5 percent; 95 percent confidence interval, 5.0 to 14.0 percent) developed an infection requiring removal of the cranioplasty. Thirty-two (21 percent; 95 percent confidence interval, 15 to 28 percent) developed clinical symptoms or signs relating to resorption of the cranioplasty. Fourteen (9 percent) required secondary titanium cranioplasty, two were offered surgical augmentation but declined, and 16 (10 percent) developed significant bone resorption through both the inner and outer tables of the skull. This study has demonstrated that the use of frozen autologous bone is associated with a high long-term failure rate; however, this does not necessarily imply that alternative materials should be routinely used. Although a number are available, their efficacy over and above frozen autologous bone remains to be established and perhaps this will only be demonstrated in the setting of a formal clinical trial. Therapeutic, IV.

The capacity of acute stress disorder to predict posttraumatic psychiatric disorders

Background One rationale for establishing the acute stress disorder diagnosis was to identify recently trauma-exposed people who may develop later posttraumatic stress disorder (PTSD). This study conducted a multi-site assessment of the extent to which ASD predicts subsequent PTSD, and also major depressive disorder, panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and substance use disorder, 12 months after trauma. Method Consecutive admissions to 5 major trauma hospitals across Australia ( N = 1084) were assessed during hospital admission and within one month of trauma exposure and subsequently re-assessed for psychiatric disorder 12 months after the initial assessment ( N = 859). Results Whereas 120 (10%) patients met criteria for ASD in the initial month after trauma, 83 (10%) met criteria for PTSD, and 268 (31%) had any psychiatric disorder at 12 months. In terms of those diagnosed with ASD, 28 (36%) subsequently met criteria for PTSD and 50 (65%) subsequently developed any psychiatric disorder. Conclusions Whereas the majority of people with ASD subsequently develop a psychiatric disorder, most people with a disorder at 12 months do not initially display ASD.

Risk Factors Related to Dysautonomia After Severe Traumatic Brain Injury

Dysautonomia after severe traumatic brain injury (TBI) is a clinical syndrome affecting a subgroup of survivors and is characterized by episodes of autonomic dysregulation and muscle overactivity. The purpose of this study was to determine the incidence of dysautonomia after severe TBI in an intensive care unit setting and analyze the risk factors for developing dysautonomia. A consecutive series of 101 patients with severe TBI admitted in a major trauma hospital during a 2-year period were prospectively observed to determine the effects of age, sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, admission Glasgow Coma Scale (GCS) score, injury severity score, emergency craniotomy, sedation or analgesia, diffuse axonal injury (DAI), magnetic resonance imaging (MRI) scales, and hydrocephalus on the development of dysautonomia. Risk factors for dysautonomia were evaluated by using logistic regression analysis. Seventy-nine of the 101 patients met inclusion criteria, and dysautonomia was observed in 16 (20.3%) of these patients. Univariate analysis revealed significant correlations between the occurrence of dysautonomia and patient age, admission GCS score, DAI, MRI scales, and hydrocephalus. Sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, injury severity score, sedation or analgesia, and emergency craniotomy did not influence the development of dysautonomia. Multivariate logistic regression revealed that patient age and DAI were two independent predictors of dysautonomia. There was no independent association between dysautonomia and admission GCS score, MRI scales, or hydrocephalus. Dysautonomia frequently occurs in patients with severe TBI. A younger age and DAI could be risk factors for facilitating the development of dysautonomia.

Multidisciplinary team response to a mass burn casualty event: outcomes and implications

To describe the characteristics of patients with burn injury admitted to a major trauma hospital in Melbourne following the Black Saturday bushfires of 7 February 2009, and to provide a detailed analysis of the hospital's response to the crisis. A retrospective chart review of ambulance and hospital records of patients admitted to the Victorian Adult Burns Service (VABS) at The Alfred Hospital (The Alfred) following the bushfires. Patient characteristics and outcomes: age, sex, total and full thickness body surface area burnt, type and site of burn, hospital and intensive care unit length of stay (LOS) and receipt of standard burn care practices. Estimated glomerular filtration rate, theatre time and LOS data for the bushfire cohort compared with corresponding data for historical cohorts from VABS and from a similar institution in New Zealand. Nineteen patients were admitted to VABS over the first 48 hours after the bushfires. Of these, nine patients were subsequently admitted to The Alfred's intensive care unit. Most patients (74%) were men with a mean age of 52.7 years (SD, 12.4 years). Seventeen patients (89%) underwent at least one surgical procedure, which resulted in 4355 minutes of theatre time for the bushfire cohort in the first week. Hospital LOS was similar for the bushfire and New Zealand cohorts. Compared with the VABS historical cohort, there was a higher incidence of abnormal renal function among the bushfire cohort patients. Although relatively few patients with severe burns were admitted to VABS, significant increases in resource allocation were required to manage them in terms of additional theatre time, consumables and staffing. The experience of VABS may aid planning for future mass burns casualty events.

Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder

Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia ( n = 244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment ( n = 208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses.

Investigating blood alcohol concentration among RTI victims admitted to hospitals in five hospitals in Vietnam

Drink driving is a major issue in Vietnam, yet, the magnitude of the problem is not adequately reported by the Government. Official statistics in 2008 revealed 6–7% of road traffic...

Posttraumatic Stress Disorder After Injury: Does Admission to Intensive Care Unit Increase Risk?

This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission. A two-group (those admitted to the ICU vs. those not admitted to ICU), prospective, cohort study of 829 randomly selected injury patients from five major trauma hospitals across Australia. We collected information on factors that may increase risk for PTSD including demographic variables (gender, age, income, education, and marital status), preinjury mental health status (prior trauma, psychiatric history, and prior social support), and injury characteristics (mild traumatic brain injury, injury severity, length of hospital admission, discharge destination, pain, and perceived threat). PTSD was measured at 12 months by structured clinical interview. ICU patients were significantly more likely to have PTSD at 12 months than trauma controls (17% vs. 7%). Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic, preinjury mental health status, and injury characteristic variables. Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.

Diagnosis of blunt traumatic ruptured diaphragm: is it still a difficult problem?

Blunt traumatic rupture of the diaphragm (BTRD) is uncommon. The diagnosis can be easily overlooked, and radiological findings misinterpreted. In a 15-year experience at the two major trauma hospitals in Brisbane reported in 1991, 85 patients with BTRD were treated, and the diagnosis not always made expeditiously. With the introduction of mandatory Early Management of Severe Trauma course training in the 90s and newer diagnostic tools, it might be expected that BTRD would be a less problematic diagnosis. The aim of this study was to review the incidence, diagnosis and outcome of BTRD at Auckland City Hospital over the last 10 years. Retrospective review of Auckland City hospital trauma registry between 1996 and 2005. Demographics include age, gender, injury severity score (ISS), length of stay, ICU admission days, methods of diagnosis and patient outcomes were reviewed. Twenty-eight patients had TRD as result of blunt injury. Median ISS was 28.5. Most of the patients were diagnosed at the time of laparotomy for other associated injuries. Road traffic crash was the most common cause. Twenty-one out of 28 patients were discharged alive. Diagnosis of BTRD remains difficult. It is rarely isolated. It requires a high index of suspicion. If suspected, chest X-ray (CXR) and other more advanced imaging modalities can be used as confirmatory tools.

The Psychiatric Sequelae of Traumatic Injury

Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status. In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N=932, 86%) and 12 months (N=817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-ups. The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders, levels of quality of life, and mental health service use and lifetime axis I psychiatric disorders. Twelve months after injury, 31% of patients reported a psychiatric disorder, and 22% developed a psychiatric disorder that they had never experienced before. The most common new psychiatric disorders were depression (9%), generalized anxiety disorder (9%), posttraumatic stress disorder (6%), and agoraphobia (6%). Patients were more likely to develop posttraumatic stress disorder (odds ratio=1.92, 95% CI=1.08-3.40), panic disorder (odds ratio=2.01, 95% CI=1.03-4.14), social phobia (odds ratio=2.07, 95% CI=1.03-4.16), and agoraphobia (odds ratio=1.94, 95% CI=1.11-3.39) if they had sustained a mild TBI. Functional impairment, rather than mild TBI, was associated with psychiatric illness. A significant range of psychiatric disorders occur after traumatic injury. The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury.

Sleep Disturbance Immediately Prior to Trauma Predicts Subsequent Psychiatric Disorder

This study investigated the extent to which sleep disturbance in the period immediately prior to a traumatic event predicted development of subsequent psychiatric disorder. Prospective design cohort study. Four major trauma hospitals across Australia. A total of 1033 traumatically injured patients were initially assessed during hospital admission and followed up at 3 months (898) after injury. Lifetime psychiatric disorder was assessed in hospital with the Mini-International Neuropsychiatric Interview. Sleep disturbance in the 2 weeks prior to injury was also assessed using the Sleep Impairment Index. The prevalence of psychiatric disorder was assessed 3 months after traumatic injury. There were 255 (28%) patients with a psychiatric disorder at 3 months. Patients who displayed sleep disturbance prior to the injury were more likely to develop a psychiatric disorder at 3 months (odds ratio: 2.44, 95% CI: 1.62-3.69). In terms of patients who had never experienced a prior disorder (n = 324), 96 patients (30%) had a psychiatric disorder at 3 months, and these patients were more likely to develop disorder if they displayed prior sleep disturbance (odds ratio: 3.16, 95% CI: 1.59-4.75). These findings provide evidence that sleep disturbance prior to a traumatic event is a risk factor for development of posttraumatic psychiatric disorder.

The Retrospective Application of a Prediction Model to Patients Who Have Had a Decompressive Craniectomy for Trauma

There is currently a resurgence of interest in the use of decompressive craniectomy. As the procedure is used more frequently, there may be an increasing number of patients surviving a severe traumatic brain injury with severe neurological impairment. The aim of this study was to determine if we could predict those cases that fall into this category. We used the web-based prediction model prepared by the CRASH collaborators and applied it to a cohort of patients who had a decompressive craniectomy in 2006 and 2007 at the two major trauma hospitals in Western Australia. All clinical and radiological data were reviewed and entered into the model, and predicted outcome and actual outcome were compared. Our analysis indicated that a significant cut-off point appeared at which the model predicted a 75% risk of an unfavorable outcome at 6 months; 19 of 27 patients with CRASH scores <75% returned to work, whereas none of the 14 patients with higher scores achieved this degree of rehabilitation at 18 months. Statistical analysis of the outcomes in our cohort confirmed that the CRASH model reliably predicted unfavorable outcome. This study demonstrated that our ability to predict poor outcome has improved.

CR34P STOMAS ARE STILL USED IN COLORECTAL TRAUMA

Purpose: We aimed to assess the management of colorectal and anal injuries in trauma patients at a single major metropolitan trauma hospital in Australia.Methods: A prospectively collected database at a major metropolitan trauma centre was assessed to retrieve consecutive patients who had colorectal and anal injuries over a 12 year period.Results: 185 patients were identified with colorectal or anal injuries from February 1996 to June 2008. The mechanism of injury was blunt in 145 (78%) with 134 (72%) related to motor vehicle trauma. The remaining 40 (22%) were due to penetrating injuries. There were 165 (89%) colonic injuries, 5 (3%) rectal injuries and 15 (8%) perineal injuries. 106 (57%) patients had multiple site of colonic or multiple organ injuries. 46 (25%) patients had full thickness tear of the colon with only 2 having full transection of the colon. The rest had contusions, serosal tears or mesocolon injury. The median injury severity score was 27 (range 4–75). 134 (72%) patients had surgical intervention including 61 repairs, 30 resections and 12 stomas, 3 of which occurred in major perineal injuries. The in hospital mortality rate was 5.4% with major or minor morbidity occurring in 52%. This included 3 anastomotic leaks and 2 missed injuries requiring a second laparotomy. 12 (6%) patients were subsequently readmitted after the initial management.Conclusion: Colorectal injuries are usually due to road trauma with the majority occurring in the colon and over half these patients have multiple injuries. The complication rate is significant but relatively few of these are related to anastomotic leak when primary anastomosis is undertaken. Stomas however continue to be used.

Acute Stress Disorder Appears Poor Predictor of PTSD

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAcute Stress Disorder Appears Poor Predictor of PTSDJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0017aCan acute stress disorder (ASD) predict posttraumatic stress disorder (PTSD)? Small studies have produced conflicting results. Now results of a larger study, conducted by Australian researchers, has sided with researchers who have found no predictive link.It was headed by Richard Bryant, Ph.D., of the University of New South Wales. Results were published in the June Journal of Clinical Psychiatry.Some 500 civilians admitted to four major trauma hospitals across Australia between April 2004 and April 2005 served as subjects in this study. Sixty-two percent had been admitted because of injury due to a motor-vehicle accident, 16 percent had been admitted because of injury due to a fall, 8 percent had been admitted because of injury due to an industrial accident, 5 percent had been admitted because of injury due to an assault, and the remaining 9 percent had been admitted for other reasons.Within a month after the subjects' hospitalization, Bryant and his coworkers used DSM-IV criteria to determine how many of them were experiencing ASD. Thirty-three (6 percent) were. Three months later, Bryant and his coworkers used DSM-IV criteria to determine how many of them had PTSD. Forty-nine (10 percent) did. Bryant and his group then looked to see how many of the 49 patients who met PTSD criteria at the three-month follow-up assessment had had ASD within the month after their trauma. They found that 15 (31 percent) had.Thus, “The majority of people who develop PTSD do not initially meet criteria for ASD,” Bryant and his team concluded. “These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.”Nonetheless, Bryant and his coworkers did find that ASD's prognostic power tended to be somewhat stronger for subjects who had experienced a brain injury in conjunction with their trauma than for those who had not. Specifically, ASD predicted PTSD in 58 percent of this sub-group of subjects, versus 31 percent for the entire subject group. This particular finding may have relevance for the many Iraq War veterans whose PTSD is coupled with traumatic brain injury (Psychiatric News, March 2, 2007).Also, since most of the subjects had been traumatized by accidental injuries, ASD might be more predictive of PTSD in patients whose trauma arises from other physical causes—say, from physical assault, sexual assault, or military combat—Bryant and his colleagues noted. Still, the rates of ASD and PTSD that they found in their subjects are similar to those that have been found in some other trauma populations, they pointed out. So their findings can probably be generalized to all trauma populations, they reasoned.All told, since an ASD diagnosis appears to have only a limited ability to foretell PTSD, at least in persons who have been traumatized by accidental injuries, better tools than an ASD diagnosis are needed to determine which trauma victims are going to develop PTSD, Bryant and his group stated. For instance, preliminary evidence suggests that trauma patients' heart rates or moods in the wake of trauma might be good bellwethers of subsequent PTSD, they said.The study was funded by Australia's National Health and Medical Research Council.An abstract of “A Multisite Study of the Capacity of Acute Stress Disorder Diagnosis to Predict Posttraumatic Stress Disorder” is posted at<www.psychiatrist.com/abstracts/abstracts.asp?abstract=200806/060806.htm>.▪ ISSUES NewArchived