Number Of Traumas Research Articles

Trauma and comorbid post-traumatic stress disorder in people with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study

BackgroundIt is estimated that up to 50 % of people with bipolar disorder (BD) also have comorbid post-traumatic stress disorder (PTSD). However, little is known about the presentation and treatment of people with this comorbidity. MethodsData from 577 individuals diagnosed with bipolar disorder participating in the Heinz C. Prechter Longitudinal Study of BD were explored at baseline, year two and four. Three trauma groups were created: (i) one trauma (n = 75), (ii) multiple traumas (n = 417), and comorbid PTSD (n = 85). Measures of depression, mania, sleep, number of hospitalisations, suicide attempts, and medication use were analysed using regression modelling to determine differences between the three trauma groups. ResultsThere was an increase in depression, mania, and sleep scores and a higher number of hospitalisations in participants with comorbid PTSD compared to those experiencing one trauma. Additionally, increased mania and depression scores were reported in participants experiencing multiple traumas compared to those with one trauma. There was no difference in medication use between those who experienced one trauma compared to those with comorbid PTSD. LimitationsThe trauma groups may include confounding with more participants experiencing PTSD than reported in this study due to screening processes. Additionally, the severity of trauma was not recorded, therefore number of traumas was utilised as a proxy. ConclusionComorbid BD and PTSD is associated with worse symptom scores compared to participants reporting one trauma. Clinical implications include the addition of trauma-informed care to clinical settings to identify PTSD to provide appropriate treatments.

Investigating Factors Affecting Mortality Due to Spinal Cord Trauma in Patients Admitted to the Intensive Care Unit.

This study was conducted to investigate the factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit (ICU). This study was conducted in a group of patients who were admitted to the ICU with a Traumatic Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS software version 16. P<0.05 was considered statistically significant. About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade. There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who had lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number of injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a significant relationship was observed between the complications caused by trauma, including cerebrovascular accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients hospitalized in the SICU (p<0.05). The patients' mortality was influenced by factors such as their level of consciousness, the number of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident, cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these complications.

Traumatic experiences in Lebanon: PTSD, associated identity and interoception

Traumatic events produce profound changes in cognition, physiological arousal, memory, and emotions and divide these integrated functions from one another. How trauma centrality in identity formation and interoceptive awareness modify trauma-related cognitive and somatic disturbances has not been studied. Aims and ObjectiveThis study proposed that trauma centrality and interoceptive awareness predicted PTSD symptomology while controlling for the type and number of traumas. MethodUsing convenient sampling, this study recruited 554 participants residing in Lebanon for the past 3 years to complete an online survey. The study used four instruments: Post-traumatic Stress Disorder Checklist (PCL-5), Centrality of Events Scale (CES), The Trauma History Screen (THS), and Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2). Hierarchical regression was conducting using SPSS to analyze the data. ResultsWhen controlling for the number and type of traumas, trauma centrality was shown to be positive significant predictor of PTSD symptomology while interoceptive awareness was shown to be negative significant predictor of PTSD symptomology. ConclusionThese findings suggest that trauma centrality in post-traumatic identity formation and interoceptive awareness may be key targets in the treatment of patients with PTSD and the clinicians’ focus may shift from traumatic event narration to investigating the effect of the traumatic experiences on cognition and somatic experience

Potential Utility of Hand Acceleration Time in Quantifying the Degree of Malperfusion in Patients With Suspected Hemodialysis Access–Induced Distal Ischemia

Steal phenomenon after upper extremity hemodialysis access is a clinical diagnosis and consists of signs and symptoms ranging from pain during dialysis to tissue loss. Duplex ultrasonography of the access site and limb arterial perfusion often serves as an adjunct to the diagnosis but can have limitations and there is no specific duplex measurement that indicates that an intervention will be a success. We have used hand acceleration time (HAT) to assess perfusion in a number of trauma and shock cases and hypothesized that this approach could also be beneficial in assessing patients with hemodialysis access–induced distal ischemia (HAIDI), both for identifying patients who are candidates for intervention and to measure whether the intervention will be successful. Specifically, we hypothesized that a HAT &lt;100 ms is associated with normal hand perfusion. We performed a retrospective review of 4 patients with upper extremity arteriovenous fistulas who presented with pain and tissue loss involving the ipsilateral hand. In 2 cases, the tissue loss was not primarily due to steal (one due to skin slough from antibiotic reaction and the other due to focal calciphylaxis), and 2 patients had diffuse calcific disease of the forearm arteries. All 4 patients had antegrade flow in the forearm arteries and HAT &gt;100 ms. One patient with soft tissue sloughing was managed with banding of the proximal fistula, and 3 had proximalization of the fistula. All 4 achieved HAT &lt;100 ms and had resolution of symptoms. Hand acceleration time may be a valuable adjunct to determine whether intervention in the setting of hemodialysis access–induced distal ischemia HAIDI may assist with wound healing.

Correlation between resilience and cognitive functioning in veterans with traumatic brain injury

Resilience in veterans with brain trauma in remote period has received considerable attention over the past years. Cognitive functioning is described among factors that may influence resilience and included in the modern theoretical models of this positive psychology phenomenon. However, the characteristics of relationship between resilience and cognitive functioning in veterans with traumatic brain injury (TBI) in remote period was not studied empirically. Therefore, the purpose of this study was to gain better understanding of the possible association between resilience and cognitive functioning in Ukrainian war veterans with traumatic brain injury in remote period. This study included 146 veterans who were admitted to two clinical hospitals for war veterans. The Connor-Davidson Resilience Scale and Montreal Cognitive Assessment Scale were used. The present study shows that lower cognitive functioning in total and in several domains is associated with less effective resilience regardless of TBI clinical type (whether it is concussion or mild cerebral contusion). Moreover, such correlation was still present after excluding the effect of age, education and TBI characteristics like number of traumas and time since last TBI. Overall, we found empirical evidence that good cognitive functioning (especially executive functions, memory, attention, abstract thinking, and orientation) is essential for effective resilience in veterans with mild TBI even years after trauma and has more effect on ability to adapt than age, education, and trauma characteristics. Educating veterans to use their cognitive potential and to compensate the restrictions after mild TBI possibly may lead to better overcoming adversities and counteracting the risks of des­adaptation and traumatic events. Therefore, psychological interventions for improving the ability to readapt and recover possibly should consider this relationship and include the component of educating veterans to use their cognitive reserve and compensate limitations to better adapt and thrive. Studies related to such interventions appear to be promising.

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

BackgroundThe pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients’ sociodemographic characteristics (age, location, gender) prior to and during the outbreak.MethodThis is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student’s t test, and Mann‒Whitney U test.ResultsThe pandemic has had two major impacts on the population’s emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured.ConclusionCollateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.

Trauma and Suicide Attempts among Insanity Acquittees.

Although many studies have assessed trauma as a suicide risk factor, to the authors' knowledge this is the first study of that risk factor among forensic psychiatric populations. Using a cross-sectional self-report survey methodology, this study investigated trauma histories, adverse childhood experiences (ACEs), posttraumatic stress disorder symptoms, and lifetime suicide attempts among forensic hospital patients adjudicated not guilty by reason of insanity ( n = 107). About 45 percent reported a previous suicide attempt and 22 percent reported multiple attempts, higher than the general population. The average number of attempts was 1.05 (2.39 among those with at least one attempt). The only PTSD symptoms significantly associated with attempting suicide were negative emotions and anhedonia, both in the cognitive/mood cluster, which was the only one of the four clusters to be significantly associated with attempting suicide. Childhood physical abuse was the only trauma significantly associated with attempting suicide. Higher number of attempts was significantly associated with ACEs (emotional neglect and abuse, sexual abuse, physical neglect, and household members with substance-related problems), number of traumas, substance-related problems (especially from alcohol), arousal symptoms (excessive startle, inattention) and negative emotions. We found several statistically significant suicide risk factors, particularly ACEs. Possible explanations and implications of the results are discussed.

COVID-19 Sokağa Çıkma Yasağının Çocuk Travmalarının Şiddeti Üzerindeki Etkisi

Aim: We aimed to evaluate the results of COVID-19 lockdown in terms of child traumas and to reveal the change in the characteristics and severity of traumas by comparing the lockdown period with the same period one year ago.&#x0D; Material and Method: The records of pediatric trauma patients at department of Kastamonu Training and Research Hospital were assessed retrospectively. The data of all pediatric traumas between the specified dates were reached and the sample of the study was determined as 1970 patients. Descriptive characteristics of patients and trauma events were determined. Patient data were re-assessed, and Pediatric Trauma Scores, and Pediatric Glasgow Coma Scale values, and Injury Severity Scores were calculated. &#x0D; Results: Of the patients, 1637 (83.1%) had admitted before the lockdown and 333 admitted during the lockdown period. It was found that the school-age children constituted the group with the most prevalent trauma patients in both periods with a rate of 76.2% before the lockdown and 49.8% in the lockdown period. It was found that the measure of lockdown reduced the rate of outdoor trauma cases from 63.2% to 43.2% (p &lt; 0.001). Whereas a statistically significant decrease was determined in the mean scores of the Pediatric Trauma Score and the Pediatric Glasgow Coma Scale, no difference was determined in the Injury Severity Score.&#x0D; Conclusion: It is seen that the COVID-19 pandemic and its restrictions, which change our normal life in every aspect, also have effects on pediatric traumas. It is noticed from our study that thanks to the lockdown, not only the number of traumas but also the severe traumas and mortality decreased.

What predicts suicidality among psychologists? An examination of risk and resilience

Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

Traumatic events, psychological symptoms, and aggression in male and female prisoners.

Objective: Establish the relationship between the types of traumatic experiences, number of traumas, age at the time of traumatic events with psychopathological symptoms and aggression in an Ecuadorian prison. Method: A cross-sectional study with 101 offenders from Ambato's Detention Center in Ecuador. Results: Of the prisoners in this sample, 27 have PTSD. Incarcerated individuals who have suffered intentional trauma, multiple traumas, and trauma before the age of 18 show higher levels of psychopathological symptoms and aggression. Conclusions: This study highlights the importance of mental health care in prisons. Research outcomes are relevant for future investigation in Latin American prisons for the design and implementation of trauma-related interventions. Trauma-focused interventions can prevent violence and mitigate its consequences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Study of the Medicolegal aspect of Trauma, Cases came to Emergency Department at Beni-Suef University Hospital “Egypt”

Trauma is the 6th leading cause of death worldwide resulting in 5 million of all deaths. It is the 5th leading cause of significant disability. In Egypt, injuries the fifth leading cause of death and the most common cause of hospitalization and account for at least 1/4 of all inpatients. The aim is to identify the medico-legal importance of different causes of orthopedic trauma to patient admitted at Beni-Suef university hospital and identify their relation with different demographic data of the patient. Data of 207 patients with orthopedic trauma admitted at Beni-Suef university hospital period from September 2016 to December 2016. Age, sex, residence, cause, site, number of trauma, type of fracture, investigation done, treatment and also associated other injuries are reported. The most common cause of trauma is motorcycle accidents (25.6%) followed by fall on ground (25.1%). Lower extremities are the most common site of trauma (44.9%). Most of cases have single fracture (71.5%) with simple type (50.3%). X-ray is the most common investigation done to patients (71%). (68.1%) of cases need operative treatment. (84%) of cases came with orthopedic trauma only not associated with other injury. While the most common associated injury is wounds over skin (5.4%). Limb injuries are a common problem among the physically active, and such injuries may result in diminished performance, reduced participation, and in the longer term loss of function, chronic joint disease, and disability. Limb injuries represent the commonest form of injury involved in road traffic accidents

THE IMPACT OF MOTORCYCLE ACCIDENTS IN A REFERENCE HOSPITAL DURING THE COVID-19 PANDEMIC.

This study aimed to analyze the relationship between the number of motorcycle accidents attended at a reference Hospital for trauma in Campinas, state of São Paulo, and the pandemic by COVID-19 during the year 2020. This is a cross-sectional, descriptive retrospective study carried out at Hospital PUC- Campinas, through the analysis of medical records of patients, victims of motorcycle trauma undergoing orthopedic surgical management in 2020. The phases of the pandemic and the isolation rates according to the São Paulo Plan were studied. Chi-Square tests, and the Least Squares method were applied for statistical calculations. 155 medical records were analyzed, of which 91.61% of the patients were male. Of those admitted, 94.84% suffered fractures and 51.61%, polyfractures. There was a correlation between the average isolation rates and the number of accidents. In the 14-day period, as the average isolation rate increased by 10%, there was an increase of approximately 3 accidents in that period. In the 7-day analysis, 1.7 more traumas were observed for every 10% increase in the average isolation. The results suggest that by increasing the average isolation rate, the number of traumas per motorcycle treated at the institution increased. Level of Evidence III, Comparative Retrospective Study.

Seek Balance: Deviation from Balance Mediates Trauma Exposure and Quality of Life

This research assessed direct and mediated relations between lifetime trauma exposure and physical and mental health, with deviation from a balanced time perspective (individuals’ perception of the past, present, and future time frames) as a potential mediator. Participants were 238 undergraduates who completed online assessments of trauma exposure, quality of life, and time perspectives. Mediation analyses revealed that a greater number of traumas indirectly influenced quality of life by way of deviation from a balanced time perspective. Discussion underscores the importance of balance in time perspectives, particularly when adjusting to adverse life events.

Pediatric eye emergency department activity during the first wave of Covid-19 pandemic

BackgroundWe investigated the volume and the characteristics of pediatric eye emergency department (PEED) consultations performed at our tertiary eye center during the early months of the COVID-19 pandemic and we compared them to those carried out in the same time interval of the previous three years.MethodsOphthalmic emergency examinations of patients aged ≤18 years old and done during the national COVID-19 lockdown (March 9th, 2020 – May 3rd, 2020) and in the corresponding date range of the previous three years (2017, 2018, and 2019) have been considered and reviewed. The following features were retrieved and analyzed: age, gender, duration and type of accused symptoms, traumatic etiology, and the discharge diagnosis.Results136, 133, and 154 PEED visits have been performed respectively in 2017, 2018, and 2019, while 29 patients presented in 2020. Therefore, the volume of PEED activity decreased by 79.4% (p < 0.0001). Demographical and clinical characteristics were comparable to those of the pre-COVID period. Despite the absolute reduction in the number of traumas, urgent conditions increased significantly from 30.7 to 50.7% (p = 0.024).ConclusionsPEED activity decreased consistently after the onset of the pandemic and it was mainly attended by those children whose conditions required prompt assistance, reducing the number of patients diagnosed with milder pathologies. At the end of the emergency, better use of PEED could avoid overcrowding and minimize waste, allowing resource optimization for the management of urgent cases.

50.7 History of Interpersonal Trauma as a Risk Factor for Psychiatric Rehospitalization Among Children and Adolescents: A Narrative Review

Childhood and adolescent psychiatric rehospitalizations are prevalent and overtaxing for patients, their families, and healthcare systems and can in themselves be traumatic to all parties involved. Understanding their causes is crucial to reduce this burden. This narrative literature review investigates the growing evidence identifying history of interpersonal trauma—defined as a type of trauma that occurs between people by acts of commission or omission, such as abuse, neglect, and bullying—as a risk factor for psychiatric rehospitalization among children and adolescents. The literature review was conducted on PubMed with the following key terms: (childhood OR adolescent OR children) AND (readmission OR rehospitalization) AND ([(interpersonal OR mental OR psychiatric) AND trauma)] OR PTSD). Three independent reviewers screened for eligible studies that discussed interpersonal trauma and psychiatric rehospitalization risk in patients aged 0 to 18 years. PubMed queries yielded 63 records with the key terms. After 3 independent reviews, 4 eligible records were found. Among the 4 retrospective studies with sample sizes between 100 and 783, three studies reported that children and adolescents who experienced neglect, bullying, physical abuse, or sexual abuse had higher psychiatric rehospitalization rates than those without. The fourth study found no significant association between interpersonal trauma and psychiatric rehospitalization but stated that underreporting of childhood interpersonal trauma may attribute to this lack of significance. All 4 studies focused on diagnosis of PTSD to account for trauma, while some, but not all, took into consideration family structure, history of abuse, and further mental health diagnosis. Current literature is limited but supports the interpretation that interpersonal trauma history is a risk factor for psychiatric rehospitalization among children and adolescents. However, the degree to which various factors, such as age, number of traumas, and types of interpersonal trauma experienced, impact this relationship remains unknown. Therefore, further studies are warranted to explore and elaborate on such elements in this emerging association.

An Investigation of the Causes of Cardiac Arrest Cases Due to Multiple Trauma

Objective: This study aimed to examine the demographic characteristics of autopsy cases due to multiple trauma and contribute to the diagnosis and treatment process. Method: Our study was carried out by examining autopsy reports of multiple trauma cases. Accordingly, two groups were formed: those who died at the scene and those in the emergency department. In addition, the demographic data of the cases, the mechanism of multiple trauma, and the cause/causes of death were recorded. Results: A total of 278 cases involving 165 deaths at the scene and 113 deaths in the emergency service were included. The most common causes of trauma in both groups were in-vehicle traffic accidents and falling from height. The most common causes of mortality in both groups were hemothorax and subarachnoidal hemorrhage. Conclusions: Deaths due to multiple trauma were almost four times more common in males (82%); the number of trauma under the age of 65 was approximately four times higher. This result shows that young men are at a much higher risk of trauma, resulting in more fatal consequences. We think our study will help to reveal the prevalence, coexistence, and trauma mechanisms of existing pathologies.

P75. Spine call coverage and seasonality are key variables involved in the workload placed on orthopaedic residents

<h3>BACKGROUND CONTEXT</h3> Excessive resident duty hours (RDH) is a recognized issue with implications in both physician well-being and patient safety. A major component of the RDH concern is on-call duty. While considerable research has been put forth to address this problem of reducing resident call workload, there is a paucity of research in optimizing resident call scheduling. Currently, call coverage is scheduled arbitrarily rather than demand-based and may lead to over-scheduling coverage in order to prevent a service gap. Machine learning and forecasting has been widely applied in other industries to prevent such issues of a service supply-demand mismatch. However, it has gained little traction in health care. We believe that forecasting principles can be used to efficiently schedule residents to optimize their time while ensuring high quality patient care. <h3>PURPOSE</h3> We test a mathematical model to determine key variables driving resident scheduling and identify potential scheduling optimization. <h3>METHODS</h3> Daily handover emails of the orthopaedics department at a major academic hospital over a 12-month period were collected. The following data was extracted: 1) spine call coverage, 2) date sent, 3) number of operating rooms (ORs) completed, 4) number of traumas, 5) number of admissions, and 6) number of consults. Combined with observation of resident responsibilities over a 12-month period, the above variables were used to calculate the demand per day in hours (demand function) required of orthopaedic residents. A linear regression model was used to determine variables that significantly contribute to the demand function. Reduction capacity was measured by determining the number of "second-call" resident shifts that were not necessary, defined by days when the daily demand was less than 20 hours. <h3>RESULTS</h3> A linear regression model determined three statistically significant variables (P<.01) involved in the demand function: 1) spine call duty, 2) weekday vs weekend, and 3) season. Mean winter demand was 22.6 hours (SD 5.9) while summer demand was 25.9 hours (SD 6.4). Mean demand on spine call was 29.9 hours (SD 8.0) and mean demand off spine call was 17.5 hours (SD 3.9). On spine call, mean winter demand was 28.4 hours (SD 7.9) while summer was 33.7 hours (SD 9.0). When not on spine call, the percentage of days with extra shifts per season was 55.3% in summer and 72.5% in winter. When on spine call, the percentage of days with extra shifts per season was 19.0% in summer and 28.9% in winter. Overall, the number of extra resident shifts was 169 per annum. <h3>CONCLUSIONS</h3> Key drivers of resident demand have been identified using a linear regression model, demonstrating potential for significant optimization of resident scheduling. Further work would involve creating a forecasting model that accurately predicts future demand based on past and current demand patterns. This work has the potential to significantly impact resident well-being while maintaining high quality patient care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Evaluation of Patterns of Trauma Reporting to the Emergency Department During the First COVID-19 Lockdown in India.

BackgroundOn March 24, 2020, the Government of India declared a nationwide lockdown and a series of measures aimed at limiting the spread of the coronavirus disease 2019 (COVID-19) infection. This led to dynamic changes in patient inflow and management in the emergency department.This study aims to evaluate the impact of the pre-lockdown and lockdown periods on the demography of trauma in a tertiary care teaching hospitaland to compare it with the homologous period of 2019.MethodsThe trauma caseloads between March 25, 2020, and April 14, 2020, and that of the homologous period of 2019 were thoroughly analyzed and compared retrospectively.ResultsThere was an overall decrease in trauma patients. Elderly male patients had an increased incidence of injury during the lockdown period with a significant p-value (0.0009). There was a significant increase in the number of minor orthopedic procedures while there was a significant decrease in the number of major orthopedic procedures. Fractures of the proximal femur were significantly increased during the lockdown period (p-value0.011) and fractures of the femur and tibia shaft were significantly decreased during the lockdown period (p-value0.002). Fractures of the distal radius were significantly increased during the lockdown period (p-value0.005) and fractures of the shaft of humerus, radius, and ulna were significantly decreased during the lockdown period (p-value0.028). Injuries following fall, trivial trauma, and animal-induced trauma were significantly increased (p-values <0.0001, <0.0001, 0.014, respectively), whereas injuries following sports and motor vehicle accidents were significantly decreased (p-value 0.006, <0.0001, respectively). The number of patients reaching within the golden hour (<1 hour) was significantly increased (p-value 0.0003). The total number of patients presenting under the influence of alcohol during the lockdown period was significantly decreased (p-value- <0.0001). The use of government-sponsored ambulances for transport to the hospital was significantly increased during the lockdown period (p <0.0001).ConclusionStrict administrative measures had a high impact on the number and epidemiology of trauma with remarkable changes. There was a decreased number of trauma cases but the mechanism, type, and management of these cases were significantly altered from the homologous period of the previous year.

Using the Decrease in Trauma Admissions During the COVID-19 Pandemic to Evaluate Compliance With Stay-at-Home and Social Distancing Guidelines.

IntroductionThe coronavirus disease 2019 (COVID-19) virus was declared a pandemic on March 10, 2020 by the World Health Organization (WHO) and has massively burdened healthcare systems with cases exponentially rising throughout the United States and the rest of the world. Since implementing precautions to reduce the spread of this disease, emergency departments have seen a decrease in the number of traumas. By evaluating the differences in the number of trauma admissions in different subgroups of patients, we can assess where to target messaging to increase compliance with these precautions. In this study, we aim to analyze the effect of the COVID-19 pandemic on trauma admissions.MethodologyThis was a retrospective review of the trauma database at our institution, a level 2 trauma center in Southern California, to assess the impact of COVID-19 on the number of traumas. The inclusion criteria were patients activated as traumas, regardless of age. Patients were excluded from the study if they did not have complete information in the trauma database. Data were stratified by date into two groups: (a) COVID period (January to April 2020) and (b) pre-COVID period (January to April 2019). The primary endpoint of this study was to determine whether there was a significant change in the number of patients presenting as trauma during the COVID-19 pandemic. This difference was analyzed and divided into subgroups based on age and trauma type.ResultsIn our review, an average of 279 patients per month presented as trauma from January to April in 2019, and an average of 222 patients per month presented as trauma from January to April 2020 (p = 0.049). We found a significant decrease in the number of patients presenting with the chief complaint of fall and vehicular accident, but a nonsignificant difference in patients presenting as assaults or pedestrian accidents. There was also a significant decrease in the number of traumas in the 18-39 and 65+ age groups and a nonsignificant decrease in the 40-64 age group. It was also noted that the number of trauma admissions in May 2020 increased to 253 compared to 269 in 2019. This increase was most notable in the 18-39 and 40-64 age groups.DiscussionAs seen in the data, the most notable year-over-year difference was seen in March and April. In California specifically, a stay-at-home order was set in place in March, which was in conjunction with the WHO’s declaration of a pandemic. An interesting finding was the significant decrease in patients with traumas in the age groups of 18-39 and 65+ from 2019 to 2020. There was a smaller, nonsignificant decrease in patients aged 40-64. This would be a good group to target with future messaging to increase compliance with health advisories. There was also a notable increase in the number of traumas in May 2020, signaling an end to the cooperation of the majority of people, also indicating that further measures needed to be enacted in all groups.ConclusionsCOVID-19 has disrupted social structures worldwide. As the pandemic continued, even the observers of stay-at-home and social distancing measures, the 18-39 age group, became fatigued with the guidelines and ventured out into the warming weather and summer activities. This difference in trauma admission due to COVID-19 between subsequent years can highlight the behavioral changes in our patient population and can be further extrapolated to target additional messaging to help reduce the spread of COVID-19.

Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey

Aim We aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children. Methods The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively. Results 20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD. Conclusions Our results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.