Post-traumatic Injury Research Articles

Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines

Injury outcomes seem to be more severe in older than younger persons. This may make personal injury assessment (PIA) particularly difficult, mainly because of seniors' previous health frailties. To set the grounds for seniors' PIA guidelines, we compared an older with a younger adult population of trauma victims and, secondarily, identified differences between the groups regarding three-dimensional and medico-legal damage parameters assessment. Using a retrospective study of victims of road traffic accidents, we compared the groups (n = 239 each), assuring similar acute injury severity (ISS standardised difference = 0.01): G1 (older adults); G2 (younger adults). Logistic regression was used to estimate the odds ratio. G1 revealed higher negative consequences when considering the three-dimensional damage assessment, with more frequent and severe outcomes, being a cause of further difficulties in daily living activities, with a loss of independence and autonomy. Nevertheless, regarding the medico-legal damage parameters, permanent functional disability did not show significant differences. This study generates evidence that reveals the need to rethink the traditional methodology of PIA in older persons, giving more relevance to the real-life contexts of each person. It is essential to: obtain complete information about previous physiologic and health states, begin the medico-legal assessment as early as possible, make regular follow-ups, and perform a multidisciplinary evaluation.

A feasibility study of psychological first aid as a supportive intervention among police officers exposed to traumatic events.

Police officers are often exposed to traumatic events, which can induce psychological distress and increase the risk of developing post-traumatic stress injuries. To date, little is known about support and prevention of traumatic events in police organizations. Psychological first aid (PFA) has been promoted as a promising solution to prevent psychological distress following exposure to a traumatic event. However, PFA has not yet been adapted to policing reality, let alone to the frequent exposure to traumatic events faced by this population. This study aimed to evaluate the feasibility of PFA as an early intervention for the prevention of post-traumatic stress injuries among police officers in Quebec, Canada. Specifically, the objectives were to evaluate: (1) the demand. (2) the practicality, and (3) the acceptability of PFA in a police organization. A feasibility study was conducted to evaluate the implementation of PFA among Quebec's provincial police force. To do so, 36 police officers participated in semi-structured interviews between October 26th, 2021, and July 23rd, 2022. Participants were comprised of responders (n = 26), beneficiaries (n = 4) and managers (n = 6). Interviews were transcribed, coded, and evaluated according to a thematic analysis. Eleven themes emerged from participants' responses. Results suggested that PFA met individual and organizational needs. References were also made regarding the impacts of this intervention. Moreover, participants provided feedback for improving the implementation and sustainability of a PFA program. All three groups of participants shared similar thematic content. Findings revealed that implementation of a PFA program in a law enforcement agency was feasible and could be accomplished without major issues. Importantly, PFA had beneficial consequences within the organization. Specifically, PFA destigmatized mental health issues and renewed a sense of hope among police personnel. These findings are in line with previous research.

Long-Term Outcomes and Risk Factors Analysis for Patients Undergoing Thoracic Endovascular Aorta Repair (TEVAR), According to the Aortic Pathologies

Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute and chronic thoracic aorta diseases. We analyzed long-term outcomes and risk factors of TEVAR procedures according to the aortic pathology. Demographics, indications, technical details, and outcomes of patients undergoing TEVAR procedures in our institutions were prospectively collected and retrospectively analyzed. Overall survival was determined using Kaplan-Meier methods while log-rank tests were used to compare the survival between groups. Cox regression analysis was used to identify risk factors. Between June 2002 and April 2020, 116 patients underwent TEVAR for different thoracic aorta diseases. Among them, 47 patients (41%) underwent TEVAR for aneurysmatic aortic disease, 26 (22%) for type-B aortic dissection, 23 (20%) for penetrating aortic ulcer, 11 (9%) after previous type-A dissection treatment, and 9 (8%) for traumatic aortic injury. Patients with posttraumatic aortic injury were younger (P<0.01) with less hypertension (P<0.01), diabetes (P<0.01), and prior cardiac surgery (P<0.01). Survival was different based on indication for TEVAR (log rank 0.024). Patients after previous type-A dissection treatment had the worst survival rate (50% at 5years) while survival for aneurysmatic aortic disease was 55% at 5years. No late death occurred in the traumatic group. Cox-regression model identified independent predictors for mortality: age (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, P=0.006), male gender (HR: 3.2, 95% CI: 1.1-9.2, P=0.028), moderate chronic obstructive pulmonary disease (HR: 2.1, 95% CI: 1.02-4.55, P=0.043), previous cardiac surgery (HR: 2.1, 95% CI: 1.008-4.5, P=0.048), and treatment indication for aneurysm (HR: 2.6, 95% CI: 1.2-5.2, P=0.008). TEVAR is a safe and effective procedure with excellent long-term results in case of traumatic aortic injury. The overall long-term survival is affected by aortic pathology, associated comorbidities, gender, and previous cardiac surgery.

Racial and Ethnic Disparities of Social Participation After Tetraplegia Injury: A Regression Analysis

ObjectiveThe first aim of this study was to determine whether the use of computers, internet, and computer assistive technology (AT) increased social participation after tetraplegia spinal cord injury. The second aim was to determine whether racial or ethnic disparities of technology use were experienced. DesignA secondary analysis of data collected by the National Spinal Cord Injury Models Systems Study (NSCIMS), an ongoing observational cohort study, was performed on a sample of 3096 participants who experienced a traumatic tetraplegic injury. ParticipantsParticipants included were at least 1-year posttraumatic tetraplegia injury and participated in NSCIMS between 2011 and 2016 (N=3096). SettingNSCIMS observational data were originally collected via in-person or phone interviews. InterventionsNot applicable. Main Outcome Measure(s)A binary logistic regression was conducted to determine whether self-reported use of computers or similar device, the internet, computer AT, race, ethnicity, and other demographics predicted high (≥80) vs low/medium (<80) social participation, measured by the Craig Handicap and Reporting Technique social integration standardized measure. ResultsCombined use of a computer, AT, and the internet predicted greater social integration by almost 175% (95% confidence interval [CI], 2.0-3.78; P<.001) compared with no device or internet use. Racial and ethnic disparities were discovered. Black participants had 28% lower odds of high social integration than White participants (95% CI, 0.56-0.92; P<.01). Hispanic ethnicity predicted 40% lower odds of high social integration compared with non-Hispanic participants (95% CI, 0.39-0.91; P=.018). ConclusionsThe internet presents an opportunity to reduce barriers to social participation and increase overall social integration after tetraplegia. However, race, ethnic, and income inequities prevent or limit access to the internet, computers, and AT after tetraplegia for Black and Hispanic people.

Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions—a retrospective MRI analysis

ObjectivesTo assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions.MethodsIn this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson’s chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni’s correction was applied.ResultsALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL.ConclusionsACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions.Key Points• ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases.• Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME.• ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.

Versatility of Local Fasciocutaneous Island Flaps for Resurfacing Soft Tissue Defects Overlying the Achilles Tendon.

Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.

Exercise Intensity and Borg’s Scale as Self-Monitoring Tools in Wheelchair Test for Soldiers with Post-traumatic Lower Limb Injury

Background: Soldiers recovering from lower limb injury must maintain their endurance to return to duty. Wheelchair is commonly used for exercising during the recovery process to maintain muscular and cardiorespiratory endurance. Aim of the study is to assess heart rate (HR) or exercise intensity and Borg’s scale as self-monitoring tools in wheelchair exercise for soldiers. Methods: Design of the study is cross-sectional internal comparison study. One hundred and four healthy, well-trained male normal soldiers (NS) performed 12 minutes tests: (1) running, (2) wheeling a sports wheelchair. Fifty injured soldiers (IS) performed 12 minutes wheeling test. HR and distance were measured using a smartwatch. The HR was then used as a measurement for exercise intensity. Borg’s perceived score of effort, dyspnea, and fatigue was obtained by conducting interviews. Result: There is no significant difference in the characteristics of NS and IS, thus the subjects in both groups are comparable. Distance and intensity values were significantly lower in the wheeling test than in the running test (P&lt;0.05). During the running test, all subjects could reach their maximum level of intensity, whereas, during the wheeling test, both NS and IS subjects reached the moderate-vigorous level of intensity. The Borg’s scale showed a significant difference in dyspnea and fatigue scores between running and wheeling (P&lt;0.05). In the NS group, an interesting phenomenon emerged, there was a difference between the onset of dyspnea and fatigue. Dyspnea occured prior to leg fatigue during the running test. On the other hand, when they performed wheeling test, dyspnoe occurs later and is not even felt, instead arm fatigue will appears fist. Conclusion: Counting of HR for exercise intensity, Borg’s scale (dyspnea and fatigue) can be a convenient alternative for self-monitoring wheeling exercise. These two tools are meant to help assessing safety and goals of exercise.

Магнітно-резонансна томографія скронево-нижньощелепного суглоба

Resume. topresent the anatomy of the temporomandibular joint of healthy people based on the results of the magnetic resonance imaging. Methods: there were examined 47 patients without the pathology of the temporomandibular joint. Results. There is presented anatomy of the temporomandibular complex based on the results of magnetic resonance imaging in patients without the pathology of temporomandibular joint. There were compared two methods of temporomandibular joint examination: CT and MRI. There are presented indications and contraindications (absolute and relative) for MRI. Knowing the anatomy of the temporomandibular joint of a healthy person when performing magnetic resonance imaging one can prove the efficiency of the examination to diagnose temporomandibular joint diseases i.e. muscular and articular dysfunction, inflammatory and dystrophic diseases, posttraumatic injuries, ankyloses, etc. Conclusions. Using the magnetic resonance imaging makes it possible to effectively diagnose degenerative, inflammatory and neoplastic diseases of joints and surrounding soft tissues as it was proved by the performed examination of the temporomandibular joint of healthy people. Key words: temporomandibular joint, mandibular bone, maxillofacial area, magnetic resonance imaging.

Systematic Review and Meta-Analysis of Sciatic Nerve Injury in Acetabular Fractures

Background: Acetabular fracture is a challenging orthopaedic injury, usually associated with post-traumatic arthritis, deep vein thrombosis, and sciatic nerve injury (SNI). Therefore, we assess the incidence and outcome of SNI associated with acetabular fractures in this study. Methodology: We applied search keywords across PubMed, clinicaltrail.gov, Scopus, and Cochrane library database from 2002 to March 2022 with the studies reporting SNI associated with acetabular fracture. Patient's demographic details, acetabular fracture type, recoveries rate and time, number of patients with acetabular fracture reporting SNI, and follow-up. Methodological Index for Observational Non-Randomized Studies (MINORS) criteria assessed the quality appraisal of each identified study. Results: This study includes twenty-one studies with a total of 682 patients, 19 iatrogenic SNI, and 44 post-traumatic injuries. Overall incidence of post-traumatic and iatrogenic SNI associated with acetabular fractures was 9% [95% CI: 6%-11%] and 5% [95% CI: 3%-7%] respectively. The overall recoveries rate from iatrogenic SNI and post-traumatic SNI associated with acetabular fracture were 55% (95% CI: 22%-83%) and 68% (95% CI: 53% -81%), respectively. The overall quality score of all included studies was 64.28± 7.43% (R: 56.25 % -81.25%), with seven studies below 60%. In most cases, Recoveries of sciatic nerve injury occur within 2-24 months after any open reduction and internal fixation (ORIF). Conclusion: This review estimates SNI incidence with acetabular fracture and recoveries rates. However, this study fails to report the association of SNI with specific acetabular fracture types due to insufficient reported data across eligible studies

New insights into the biological roles of immune cells in neural stem cells in post-traumatic injury of the central nervous system.

Traumatic injuries in the central nervous system, such as traumatic brain injury and spinal cord injury, are associated with tissue inflammation and the infiltration of immune cells, which simultaneously affect the self-renewal and differentiation of neural stem cells. However, the tissue repair process instigated by endogenous neural stem cells is incapable of restoring central nervous system injuries without external intervention. Recently, resident/peripheral immune cells have been demonstrated to exert significant effects on neural stem cells. Thus, the restoration of traumatic injuries in the central nervous system by the immune intervention in neural stem cells represents a potential therapeutic method. In this review, we discuss the roles and possible mechanisms of immune cells on the self-renewal and differentiation of neural stem cells along with the prognosis of central nervous system injuries based on immune intervention. Finally, we discuss remaining research challenges that need to be considered in the future. Further elucidation of these challenges will facilitate the successful application of neural stem cells in central nervous system injuries.

Characterization of female reproductive disturbances post-traumatic injury in Drosophila melanogaster.

Traumatic injuries (TIs) from intimate partner violence, vehicular collisions, high-impact sports, and even mundane activities can be fatal. However, survivors of TIs can have pathophysiological disturbances post-injury, including neurodegenerative diseases, mental illness, and metabolic disorders.Reproductive issues are a known consequence of TI especially in women, however this has remained poorly understood. Drosophila melanogaster has recently emerged as a stellar model of TI, however reproductive consequences have not been reported. Using the Drosophila model, we find reproductive consequences in the form of decreased egg laying and the retention of mature egg chambers mimicking issues in ovulation. These findings indicate that reproductive consequences of TI are conserved between Drosophila and humans.

Current status of post-traumatic injury with acute gastrointestinal injury and progress in diagnosis and treatment

Hypertriglyceridemia is the third most common cause of acute pancreatitis worldwide, and in China, it is the second leading cause. It mainly affects patients with underlying lipoprotein metabolism disorders and comorbidities like diabetes mellitus, alcohol abuse, or drug use. Pancreatitis caused by hypertriglyceridemia has similar clinical manifestations to acute pancreatitis caused by other factors but has a longer course and more complications, increasing the likelihood of organ failure. Treatment involves aggressive fluid resuscitation, pain control, and nutritional support, similar to acute pancreatitis from other causes. Timely recognition of hypertriglyceridemia is crucial for proper management, preventing recurrence, and long-term disease management.

Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study.

Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma. We performed a case-control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors. The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001). The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation. Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023;27(1):22-25.

Ultrasound examination and follow-up of post traumatic injury of the proximal lateral head of gastrocnemius

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Role of Sromal Vascular Fraction in Wound Bed Preparation in Post Traumatic Wound

Degloving Injury are major debilitating conditions and its treatment is also challenging. The treatment of post traumatic degloving injury requires a multimodal approach. Adjuvant platelet rich fibrin matrix can be tried for post traumatic wounds as a modality for wound bed preparation. In this study we share our experience regarding the use of stromal vascular fraction as an adjunct in the management of post-traumatic degloving wounds of the lower extremity.

Assessment of Posttraumatic Bodily Injury in Road Accidents – Legal and Medico – Legal Criteria

Assessment of Posttraumatic Bodily Injury in Road Accidents – Legal and Medico – Legal Criteria

Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel.

Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder. The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date. The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers. Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022-Prospectively registered. ClinicalTrials.gov, NCT05530642. Registered 1 September 2022-Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.

Magnetic resonance imaging (MRI) findings after knee, foot, and ankle traumas.

The aim of this study is to investigate the demographic and clinical characteristics of knee and ankle traumas that could not be detected in the first post-traumatic evaluation and diagnosed within 15 days after the follow-up examination and to discuss the results we obtained with current data. Patients admitted to the emergency department trauma department between January 1, 2017, and December 31, 2018, were retrospectively analyzed. Applications due to traffic accidents and all traumas except knee and ankle trauma were excluded from the study. Medical records were used to reveal the demographic characteristics of the cases, clinical findings, mechanisms of injury, additional injuries, and interventions in the emergency room. The mean age of 2,039 patients included in the study due to knee, foot, and ankle trauma was 35.69±12.01, and the median value was 36 (age range 11-71). The patients were divided into 2 groups knee trauma and ankle trauma and statistical evaluations were made. Of the patients evaluated for knee trauma (n=1,157), 463 (40%) were female and 694 (60%) were male. Of the patients evaluated for ankle trauma (n=882), 397 (45%) were female and 485 (55%) were male. It is evident that knee, foot, and ankle traumas after simple falls and sports injuries are frequently encountered by emergency physicians. It is known that post-traumatic ligament injury, bone contusion, intraarticular fluid/hematoma formation, and fractures that cannot be detected by radiographs can be overlooked in emergency departments where patient density is high.

Is the Lifetime Malignancy Risk in United States Military Personnel Sustaining Combat-related Trauma Increased Because of Radiation Exposure From Diagnostic Imaging?

Patients with complex polytrauma in the military and civilian settings are often exposed to substantial diagnostic medical radiation because of serial imaging studies for injury diagnosis and subsequent management. This cumulative radiation exposure may increase the risk of subsequent malignancy. This is particularly true for combat-injured servicemembers who receive care at a variety of facilities worldwide. Currently, there is no coordinated effort to track the amount of radiation exposure each servicemember receives, nor a surveillance program to follow such patients in the long term. It is important to assess whether military servicemembers are exposed to excessive diagnostic radiation to mitigate or prevent such occurrences and monitor for carcinogenesis, when necessary. The cumulative amount of radiation exposure for combat-wounded and noncombat-wounded servicemembers has not been described, and it remains unknown whether diagnostic radiation exposure meets thresholds for an increased risk of carcinogenesis. We performed this study to (1) quantify the amount of exposure for combat-wounded servicemembers based on medical imaging in the first year after injury and compare those exposures with noncombat-related trauma, and (2) determine whether the cumulative dose of radiation correlates to the Injury Severity Score (ISS) across the combat-wounded and noncombat-wounded population combined. We performed a retrospective study of servicemembers who sustained combat or noncombat trauma and were treated at Walter Reed National Military Medical Center from 2005 to 2018. We evaluated patients using the Department of Defense Trauma Registry. After consolidating redundant records, the dataset included 3812 unique servicemember encounters. Three percent (104 of 3812) were excluded because of missing radiation exposure data in the electronic medical record. The final cohort included 3708 servicemembers who had combat or noncombat injury trauma, with a mean age at the time of injury of 26 ± 6 years and a mean ISS of 18 ± 12. The most common combat trauma mechanisms of injury were blast (in 65% [2415 of 3708 patients]), followed by high-velocity gunshot wounds (in 22% [815 of 3708 patients]). We calculated the cumulative diagnostic radiation dose exposure at 1 year post-traumatic injury in patients with combat-related trauma and those with noncombat trauma. We did this by multiplying the number of imaging studies by the standardized effective radiation dose for each imaging study type. We then performed analysis of variance for four data subsets (battle combat trauma, nonbattle civilian trauma, high ISS, and high radiation exposure [> 50 mSv]) independently. To evaluate whether the total number of imaging studies, radiation exposure, and ISS values differed between battle-wounded and nonbattle-wounded patients, we performed a pairwise t-test. The mean radiation exposure for combat-related injuries was 35 ± 26 mSv while the mean radiation exposure for noncombat-related injuries was 22 ± 33 mSv in the first year after injury. In the first year after trauma, 44% of patients (1626 of 3708) were exposed to high levels of radiation that were greater than 20 mSv, and 23% (840 of 3708) were exposed to very high levels of radiation that were greater than 50 mSv. Servicemembers with combat trauma-related injuries had eight more imaging studies than those who sustained noncombat injuries. Servicemembers with combat trauma injuries (35 ± 26 mSv) were exposed to more radiation (approximately 4 mSv) than patients treated for noncombat injuries (22 ± 33 mSv) (p = 0.01). We found that servicemembers with combat injuries had a higher ISS than servicemembers with noncombat trauma (p < 0.001). We found a positive correlation between radiation exposure and ISS for servicemembers. The positive relationship between radiation exposure and ISS held for combat trauma (r 2 = 0.24; p < 0.001), noncombat trauma (r 2 = 0.20; p < 0.001), servicemembers with a high ISS (r 2 = 0.10; p < 0.001), and servicemembers exposed to high doses of radiation (r 2 = 0.09; p < 0.001). These data should be used during clinical decision-making and patient counseling at military treatment facilities and might provide guidance to the Defense Health Agency. These recommendations will help determine whether the benefits of further imaging outweigh the risk of carcinogenesis. If not, we need to develop interdisciplinary clinical practice guidelines to reduce or minimize radiation exposure. It is important for treating physicians to seriously weigh the risk and benefits of every imaging study ordered because each test does not come without a cumulative risk. Level III, therapeutic study.

Psychological interventions for post-traumatic stress injuries among public safety personnel: a systematic review and meta-analysis

BackgroundPublic safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various post-traumatic stress injuries (PTSIs). While there are many evidence-based psychological interventions for PTSI, the effectiveness of each intervention for PSP remains unclear.ObjectivesThe current study assessed the effectiveness and acceptability of psychological interventions for PTSI among PSPs.MethodsA systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, post-traumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen’s d), rate ratios (RR), and their 95% confidence intervals (95% CI) to measure pooled effect sizes across studies; negative d values and RR values less than one indicated a reduction in symptoms compared to baseline or control groups. In addition, heterogeneity was quantified using I2, and publication bias was evaluated using Egger’s test.ResultsThe analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioral therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counseling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d = − 1.23; 95% CI − 1.81, − 0.65; 7 studies; I2 = 81%), anxiety (− 0.76; 95% CI − 1.28, − 0.24; 3 studies; I2 = 47%), and depression (d = − 1.10; 95% CI − 1.62, − 0.58; 5 studies; I2 = 64%). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d = − 1.29 [− 2.31, − 0.27]), anxiety (d = − 0.82 [− 1.20, − 0.44]), and depression (d = − 0.46 [− 0.77, − 0.14]). There were no statistically significant differences in dropout rates (RR = 1.00 [0.96, 1.05]), suggesting high acceptability across interventions.ConclusionsThere is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies on PSP indicates a need for additional research into treating PTSI among PSP.Systematic review registrationPROSPERO: CRD42019133534.