Relevant Trauma Research Articles

Predictive parameters for early detection of clinically relevant abdominal trauma in multiple-injury or polytraumatised patients: a retrospective analysis

Diagnosis of relevant organ injury after blunt abdominal injury (AI) in multiple-injury/polytraumatised patients is challenging. AI can be distinguished between injuries of parenchymatous organs (POI) of the upper abdomen (liver, spleen) and bowel and mesenteric injuries (BMI). Still, such injuries may be associated with delays in diagnosis and treatment. The present study aimed to verify laboratory parameters, imaging diagnostics, physical examination and related injuries to predict intraabdominal injuries. This retrospective, single-centre study includes data from multiple-injury/polytraumatised patients between 2005 and 2017. Two main groups were defined with relevant abdominal injury (AI+) and without abdominal injury (AI−). The AI+ group was divided into three subgroups: BMI+, BMI+/POI+, and POI+. Groups were compared in a univariate analysis for significant differences. Logistic regression analysis was used to determine predictors for AI+, BMI+ and POI+. 26.3% (271 of 1032) of the included patients had an abdominal injury. Subgroups were composed of 4.7% (49 of 1032) BMI+, 4.7% (48 of 1032) BMI+/POI+ and 16.8% (174 of 1032) POI+. Pathological abdominal signs had a sensitivity of 48.7% and a specificity of 92.4% for AI+. Transaminases were significantly higher in cases of AI+. Pathological computed tomography (CT) (free fluid, parenchymal damage, Bowel Injury Prediction Score (BIPS), CT Grade > 4) was summarised and had a sensitivity of 94.8%, a specificity of 98%, positive predictive value (PPV) of 94.5% and, negative predictive value (NPV) of 98.2% for AI+. The detected predictors for AI+ were pathological abdominal findings (odds ratio (OR) 3.93), pathological multi-slice computed tomography (MSCT) (OR 668.9), alanine (ALAT) ≥ 1.23 µmol/ls (OR 2.35) and associated long bone fractures (OR 3.82). Pathological abdominal signs, pathological MSCT and lactate (LAC) levels ≥ 1.94 mmol/l could be calculated as significant risk factors for BMI+. For POI+ pathological abdominal MSCT, ASAT ≥ 1.73 µmol/ls and concomitant thoracic injuries had significant relevance. The study presents reliable risk factors for abdominal injury and its sub-entities. The predictors can be explained by the anatomy of the trunk and existing studies. Elevated transaminases predicted abdominal injury (AI+) and, specifically, the POI+. The pathological MSCT was the most reliable predictive parameter. However, it was essential to include further relevant parameters.

Chronic invasive fungal rhinosinusitis with septal perforation: a case report

Background: Chronic Invasive Fungal Rhinosinusitis (CIFRS) is a sub-entity of fungal rhinosinusitis, with the most common causes being Aspergillus and Mucor. Non-specific symptoms such as nasal obstruction, headaches, face pain, rhinorrhea, and epistaxis are frequently observed in patients with CIFRS. Extension to the nasal septal is a scarce case. This case report aims to present a rare case report of a 50-year-old female considered immunocompetent with chronic invasive fungal rhinosinusitis with septal perforation at our hospital who underwent Functional Endoscopic Sinus Surgery (FESS). Case Presentation: Fifty-year-old female was referred to the Otorhinolaryngology Department, Mangusada Regional Hospital, with a blocked nose, especially on the right side, with frequently purulent nasal discharge, headache, and she had a foul smell in the nose for about 5 years, then in the last few months, the symptoms became worse, and she frequently had bloody discharge and anosmia. The patient came to our hospital due to failure of previous medical therapy. She denied any history of underlying systemic disease, relevant trauma, and nasal surgery. A large polypoid mass with an obstructed right middle meatus was detected on nasal endoscopy. A dark-brown substance resembling clay was found in the right posterior nasal cavity, close to the posterior nasal septum. The same material was seen in the left posterior nasal cavity, close to the posterior nasal septum. Computed Tomography (CT)-scan demonstrated a soft tissue density in the right maxillary sinus. The density extended into the left nasal cavity through a septal defect. The patient was done surgically with FESS to restore the drainage of the nasal cavity and paranasal sinuses. It is crucial to remove all the debris and infected tissue altogether. After the surgery, the patient was given nasal irrigation therapy with physiological saline solution 2 times a day and the condition improved. Conclusion: Diagnosing invasive fungal rhinosinusitis can be challenging due to its non-specific clinical presentation. Awareness, early diagnosis, and intervention help prevent permanent complications.

Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments: A Novel Training Curriculum.

Providing resilient Damage Control Resuscitation capabilities as close to the point of injury as possible is paramount to reducing mortality and improving patient outcomes for our nation's warfighters. Emergency Fresh Whole Blood Transfusions (EFWBT) play a critical role in supporting this capability, especially in future large-scale combat operations against peer adversaries with expected large patient volumes, restrictive operating environments, and unreliable logistical supply lines. Although there are service-specific training programs for whole blood transfusion, there is currently no dedicated EFWBT training for future military medical officers. To address this gap, we developed, implemented, and evaluated a training program to enhance EFWBT proficiency in third-year military medical students at the F. Edward Hebert School of Medicine at the USU. After reviewing both the 75th Ranger Regiment Ranger O-Low Titer program and the Marine Corps' Valkyrie program, along with the relevant Joint Trauma System Clinical Practice Guidelines, we created a streamlined and abbreviated training curriculum. The training consisted of both online preparatory materials as well as a 2-hour in-person training that included didactic and experiential learning components. Participants were 165 active duty third-year medical students at USU. Participants were assessed using a pre- and post-assessment self-reported questionnaire on their confidence in the practical application and administrative oversight requirements of an EFWBT program. Participants' performance was also assessed using a pre/post knowledge assessment consisting of 10 multiple choice questions identified as critical to understanding of the academic principles of EFWBT along with the baseline questionnaire. Differences in the mean scores of the pre- and post-assessment self-reported questionnaire (increased from 2.32 to 3.95) were statistically significant (P < .001). Similarly, there was a statistically significant improvement in student test scores, with the mean score increasing by approximately 3 points or 30%. There was no significant difference in student confidence assessment or test scores based on branch of service. Students who had previously deployed did not show a statistically significant difference in scores compared to students who had not previously deployed. Our results suggest that the implementation of streamlined EFWBT training into the undergraduate medical education of future military medical officers offers an efficient way to improve their baseline proficiency in EFWBTs. Future research is needed to assess the impact of this training on real-world applications in forward-deployed environments.

Mental Health of Adolescents Exposed to the War in Ukraine

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented. To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure. This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war. Self-reported exposure to war. A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated. A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25). The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

Vagus nerve stimulation rescues persistent pain following orthopedic surgery in adult mice.

Postoperative pain is a major clinical problem imposing a significant burden on patients and society. In a survey 2 years after orthopedic surgery, 57% of patients reported persisting postoperative pain. However, only limited progress has been made in the development of safe and effective therapies to prevent the onset and chronification of pain after orthopedic surgery. We established a tibial fracture mouse model that recapitulates clinically relevant orthopedic trauma surgery, which causes changes in neuropeptide levels in dorsal root ganglia and sustained neuroinflammation in the spinal cord. Here, we monitored extended pain behavior in this model, observing chronic bilateral hindpaw mechanical allodynia in both male and female C57BL/6J mice that persisted for >3 months after surgery. We also tested the analgesic effects of a novel, minimally invasive, bioelectronic approach to percutaneously stimulate the vagus nerve (termed percutaneous vagus nerve stimulation [pVNS]). Weekly pVNS treatment for 30 minutes at 10 Hz for 3 weeks after the surgery strongly reduced pain behaviors compared with untreated controls. Percutaneous vagus nerve stimulation also improved locomotor coordination and accelerated bone healing. In the dorsal root ganglia, vagal stimulation inhibited the activation of glial fibrillary acidic protein-positive satellite cells but without affecting microglial activation. Overall, these data provide novel evidence supportive of the use of pVNS to prevent postoperative pain and inform translational studies to test antinociceptive effects of bioelectronic medicine in the clinic.

Developing and evaluating a major trauma course and coaching programme for ward nurses.

Nurses working with major trauma patients in ward environments in the UK are expected to evidence their knowledge and skills in a set of national competencies. This article describes a bespoke major trauma course and a coaching and portfolio development programme designed to enhance ward nurses' knowledge and skills, help them evidence their competence and support their professional development. Evaluation of the course showed an overall improvement in nurses' self-rated competence and confidence in a range of relevant major trauma topics and clinical skills. Evaluation of the coaching and portfolio development programme showed that nurses believed their knowledge and skills had improved after taking part and that they valued the opportunity for professional development.

Review article: Pre-hospital trauma guidelines and access to lifesaving interventions in Australia and Aotearoa/New Zealand.

The centralisation of trauma services in western countries has led to an improvement in patient outcomes. Effective trauma systems include a pre-hospital trauma system. Delivery of high-level pre-hospital trauma care must include identification of potential major trauma patients, access and correct application of lifesaving interventions (LSIs) and timely transport to definitive care. Globally, many nations endorse nationwide pre-hospital major trauma triage guidelines, to ensure a universal approach to patient care. This paper examined clinical guidelines from all 10 EMS in Australia and Aotearoa/New Zealand. All relevant trauma guidelines were included, and key information was extracted. Authors compared major trauma triage criteria, all LSI included in guidelines, and guidelines for transport to definitive care. The identification of major trauma patients varied between all 10 EMS, with no universal criteria. The most common approach to trauma triage included a three-step assessment process: physiological criteria, identified injuries and mechanism of injury. Disparity between physiological criteria, injuries and mechanism was found when comparing guidelines. All 10 EMS had fundamental LSI included in their trauma guidelines. Fundamental LSI included haemorrhage control (arterial tourniquets, pelvic binders), non-invasive airway management (face mask ventilation, supraglottic airway devices) and pleural wall needle decompression. Variation in more advanced LSI was evident between EMS. Optimising trauma triage guidelines is an important aspect of a robust and evidence driven trauma system. The lack of consensus in trauma triage identified in the present study makes benchmarking and comparison of trauma systems difficult.

Differences in Trampoline-Related Knee Injuries Between Children and Adults: A Cross-Sectional Study.

Little is known about the specific risk of knee injuries due to trampoline accidents in adults compared with children. To investigate the differences in trampoline-related knee injuries between children and adults and identify risk factors and protective strategies to reduce injury incidence. Cross-sectional study; Level of evidence, 3. Data on 229 consecutive patients treated for trampoline-related knee injuries in a single institution were prospectively collected, analyzed, and included. Risk factors, injury patterns, and clinical treatments were compared between skeletally immature and skeletally mature patients. Logistic regression was used to determine the odds ratios for specific risk factors for trampoline-related injuries-including body mass index (BMI), trauma mechanism, patient age, and accident location. A total of 229 patients met the inclusion criteria; 118 (52%) patients (women, 54.2%; mean age, 8.5 ± 4.1 years) were skeletally immature at the time of injury, and 111 (48%) patients (women, 72%; mean age, 31.9 ± 13.1 years) had closed physes on initial presentation and were classified as skeletally mature. A total of 63 patients (28%) required surgical treatment for their knee injury. Overall, 50 anterior cruciate ligament (ACL) tears, 46 fractures, 39 meniscal tears, 31 ligamentous tears other than ACL, 22 patellar dislocations, and 38 soft tissue injuries, such as lacerations, were recorded. Skeletally mature patients had 7.8 times higher odds (95% CI, 1.6-46.8; P < .05) and 19.1 increased odds (95% CI, 5.5-74.9; P < .05) of an ACL tear or another ligamentous tear, respectively, compared with skeletally immature patients. Patients who described instability and giving way of the knee as relevant trauma mechanisms had odds of 3.11 (95% CI, 0.9-14.8; P < .05) of an ACL tear compared with other trauma mechanisms. Meniscal tears were observed more frequently in the skeletally mature cohort (P < .05). An elevated BMI was associated with a significantly higher relative risk of an ACL tear, a ligamentous tear other than the ACL, and an injury requiring surgery. A third of surgically treated patients were subject to a delayed diagnosis. Adults had a significantly increased risk of ligamentous and meniscal tears and required operative intervention more often than skeletally immature individuals. Elevated BMI, age, and instability events in terms of trauma mechanism conveyed an increased risk of structural damage to the knee.

Who, When, Why?-Traumatological Patients in the Emergency Department of a Maximum Care Provider.

Nationwide, there is an annual increase in the number of patients in German emergency departments resulting in a growing workload for the entire emergency department staff. Several studies have investigated the situation in emergency departments, most of which were interdisciplinary, but there are no data on a solely traumatological patient population. The present study therefore aims to investigate the situation in a university-based trauma surgery emergency department. A total of 8582 traumatological patients attending a university hospital from 1 January 2019 to 31 December 2019 were studied. Various variables, such as reason for presentation, time of accident, diagnosis, and diagnostic as well as therapeutic measures performed were analyzed from the admission records created. The mean age was 36.2 years, 60.1% were male, 63.3% presented on their own to the emergency department, and 41.2% presented during regular working hours between 8:00 a.m. and 6:00 p.m., Monday through Friday. The most common reason for presentation was outdoor falls at 17.4%, and 63.3% presented to the emergency department within the first 12 h after the sustained trauma. The most common diagnosis was bruise (27.6%), and 14.2% of patients were admitted as inpatients. Many of the emergency room patients suffered no relevant trauma sequelae. In order to reduce the number of patients in emergency rooms in the future, existing institutions in the outpatient emergency sector must be further expanded and effectively advertised to the public. In this way, the emergency medical resources of clinics, including staff, can be relieved to provide the best possible care for actual emergency patients.

Differences in perceived threat and trauma in children during the COVID-19 pandemic

BackgroundThe past 2 years of the COVID-19 pandemic were stressful for most children and adolescents; some children may have experienced a high level of stress and trauma. To date, no study has examined self-reported stress and trauma levels due to COVID-19 in children. This study aimed to assess perceived threat, exposure and trauma symptoms in children aged 7–13 years. In addition, we explored whether parent-reported factors could predict a higher risk of COVID-19 vulnerability in their children.MethodCross-sectional data were collected from 752 children to assess COVID-19 threat, exposure and trauma symptoms using the self- and parent-reported Child and Adolescent Trauma Screening Self-Report (CATS) Trauma questionnaire. We used exploratory analyses (factor analysis of mixed data and hierarchical clustering) to identify subgroups (i.e., clusters) of children sharing similar characteristics in the dataset. Linear regression modeling was applied to determine the likelihood of higher threat and vulnerability in children with parent-reported COVID-19 threat, exposure, CATS trauma symptoms, behaviors on the Child Behavior Checklist (CBCL), and posttraumatic growth (PTG).ResultsWe identified a high-risk group of children reporting clinically relevant trauma symptoms and COVID-19-related fears. Parents’ reports of trauma could be used to identify children at high risk.ConclusionsApproximately 25% of children reported moderate to clinically relevant levels of trauma symptom. It is especially important to offer adequate support to these children to ease the trauma and prevent their symptoms from developing into psychopathology.

Predictors and characteristics of Rib fracture following SBRT for lung tumors

BackgroundThe utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures.MethodsWe retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location).ResultsA total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients.ConclusionsNearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.

Thoracoscopic Resection of Lung Nodules following CT-Guided Labeling in Children and Adolescents with Solid Tumors

Resection of lung metastases in children with solid tumors is regularly hampered by limited intraoperative detectability and relevant operative trauma of the open surgical access. The aim of this study was to analyze thoracoscopic resection of lung metastases in children following CT-guided labeling with coil wires. We retrospectively analyzed data of children and adolescents undergoing this approach at our institution between 2010 and 2022 with regard to technical aspects as well as surgical and oncological data. Within this period, we performed this procedure on 12 patients wherein we resected 18 lesions (1-5 per patient). The median age of patients was 178 months (51-265). The median duration of coil wire placement was 41 min (30-173) and the median surgery time was 53 min (11-157). No conversions were necessary and no intraoperative complications occurred. Complete microscopic resection (R0) was achieved in all labeled lesions and malignant tumor components were found in 5/12 patients. Our study shows that with a careful patient selection, thoracoscopic resection of lung metastases after coil wire labeling is a safe and reproducible procedure in children. Using this approach, lesions that are expected to have a reduced intraoperative detectability during open surgery become resectable. Patients benefit from the minimally invasive surgical access and reduced operative trauma.

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism

PurposeStatic progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS. MethodsA retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference. ResultsIn total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy. ConclusionThe SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.

Clinically relevant historical trauma sequelae: A systematic review.

The purpose of this systematic review (SR) was to present the current state of research on historical trauma, and the topics closely related to its semantic space that include intergenerational trauma, collective trauma, and extended cultural bodily and mental responses, in order to identify gaps in the literature that need to be addressed. A search of empirical studies from 1990 to 2022 was performed via Scopus, Web of Science, MEDLINE, EBSCOhost-PsychInfo, and Embase, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The initial search yielded 1012 studies, 52 of which were included in the current review. The results show that the historical trauma concept has a high potential for new research in the field of Global Mental Health. Gaps in the literature were identified, including a lack of standard features of historical trauma, and assessments of historical trauma in additional contexts than its original fields of application with Indigenous Americans. Although the introduction of the concept of historical trauma was intended to fill the gap of trauma-related difficulties not covered by the criteria of post-traumatic stress disorder (PTSD), this concept needs further scientific refinement.

The value of performing cerebrovascular CT angiography in major trauma patients: a 5-year retrospective review

To assess whether routine cerebrovascular imaging is required in all major trauma (MT) patients. All MT patients with cerebrovascular imaging between January 2015 and December 2020 were included in the study. Data were collated regarding the type of indication for computed tomography (CT) angiography imaging, time interval from the initial trauma, relevant trauma diagnoses on initial trauma imaging, and CT angiography. Findings, such as aneurysms, vascular malformations, luminal thrombus, venous sinus thrombosis, or vascular injury, were collated. Subsequent treatment with anti-coagulants/anti-platelets or surgical/radiological intervention was noted. Follow-up imaging was assessed for residual injury or complications. Two hundred and fifty of the 6,251 MT patients underwent dedicated cerebrovascular imaging and were included in the study. Of these 41 (16.4%) had cervical artery or venous sinus injury. Further positive vascular findings were identified in 25/250 patients who presented with an incidental stroke or a vascular abnormality and were mislabelled as MT patients at presentation. One patient with a carotid injury subsequently died following a large infarction. Another patient with vertebral artery injury suffered a non-lethal stroke. No patients underwent surgery or intervention. The present study showed that the overall incidence of detected blunt cerebrovascular injuries was very low (0.6%) and even lower for symptomatic vascular injury (0.03%). Routine cerebrovascular imaging is not recommended in all MT trauma patients, but instead, a continued case-by-case basis should be considered.

Neurodivergence, Embodiment, Empowerment, Pathography: Expressions from the Margins

Abstract G. Thomas Couser (1997:533) asserts in “Disability, Life Narrative, and Representation,” “The autobiographical act models the agency and self-determination the disability rights movement has fought for....” With autoethnographical prose, focusing on individual and community psychosocial implications of trauma, the paper offers story and analysis centered on embodied experience. This paper grounds lived experience of severe traumatic brain injury (TBI) with a lens of de-medicalizing disability. This paper provides windows on largely hidden and little understood forms of impairment from a frequently marginalized individual. The paper examines the experiences of a severe TBI survivor by exploring the temporal dissonance of impaired cognitive processing. The paper uses pathography to give emphasis to relevant Critical Disability Studies and Critical Trauma Studies scholarship. The paper explores how the intersections of living with multiple impairments (disabilities) while pursuing autoethnography as an unaffiliated researcher strengthens disabled identity, empowers the drive for self-determination, and provides agency to assert oneself politically to better reduce stigma and minimize oppression by the dominant culture. This paper examines the confluence of composing personal experiences of severe TBI survival with Disability Studies scholarship that promotes centering of self and (re)creating identity.

The Tibial Fracture-Pin Model: A Clinically Relevant Mouse Model of Orthopedic Injury.

The tibial fracture-pin model is a mouse model of orthopedic trauma and surgery that recapitulates the complex muscle, bone, nerve, and connective tissue damage that manifests with this type of injury in humans. This model was developed because previous models of orthopedic trauma did not include simultaneous injury to multiple tissue types (bone, muscle, nerves) and were not truly representative of human complex orthopedic trauma. The authors therefore modified previous models of orthopedic trauma and developed the tibial fracture-pin model. This modified fracture model consists of a unilateral open tibial fracture with intramedullary nail (IMN) internal fixation and simultaneous tibialis anterior (TA) muscle injury, resulting in mechanical allodynia that lasts up to 5 weeks post injury. This series of protocols outlines the detailed steps to perform the clinically relevant orthopedic trauma tibial fracture-pin model, followed by a modified hot plate assay to examine nociceptive changes after orthopedic injury. Taken together, these detailed, reproducible protocols will allow pain researchers to expand their toolkit for studying orthopedic trauma-induced pain.

Post-trauma behavioral phenotype predicts the degree of vulnerability to fear relapse after extinction in male rats

Current treatments for trauma-related disorders remain ineffective for many patients.1,2 Fear extinction deficiency is a prominent feature of these diseases,3 and many behavioral treatments rely on extinction training.4,5 However, in many patients, therapy is followed by a relapse of symptoms, and the underpinnings of such interindividual variations in vulnerability to relapse remain unknown.6-8 Here, we modeled interindividual differences in post-therapy fear relapse with an ethologically relevant trauma recovery paradigm. After fear conditioning, male rats underwent fear extinction while foraging in a large enriched arena, permitting the expression of a wide spectrum of behaviors. An automated multidimensional behavioral assessment revealed that post-conditioning fear response profiles clustered into two groups: some animals expressed fear by freezing more, whereas others darted more, as if fleeing from danger. Remarkably, the tendency of an animal to dart or to freeze after CS presentation during the first extinction session was, respectively, associated with stronger or weaker fear renewal. Moreover, genome-wide transcriptional profiling revealed that these groups differentially regulated specific sets of genes, some of which were previously implicated in anxiety and trauma-related disorders. Our results suggest that post-trauma behavioral phenotypes and the associated gene expression landscapes can serve as markers of fear relapse susceptibility and thus may be instrumental for future development of more effective treatments for psychiatric patients.

Why Trauma Care is Not Expensive: Detailed Analysis of Actual Costs and Cost Differences of Patient Cohorts.

Trauma patients are resource intensive, requiring a variety of medical and procedural interventions during hospitalization. These expenses often label trauma care as "high cost" based on gross hospital charges. We hypothesized that a financial metric built on actual costs and clinically relevant trauma patient cohorts would demonstrate a lower true cost of trauma care than the standardly reported gross hospital charges. We examined all trauma patients (≥16yr) treated in 2017 from a single institution and matched them to the institution's detailed financial accounting data. The organization's Financial Operations Division is uniquely able to allocate total operating costs across patient encounters to include medications, procedures, and salaries/fees from medical professionals and administrators. Patient subgroups were identified by Trauma Quality Improvement Program (TQIP) criteria for cost comparisons. Overall median cost per patient was $6,544 [IQR $4,975-14,532] for 2,548 patients. The median cost per patient increased with Injury Severity Score (ISS) ranging from $5,457(ISS ≤ 7) to $34,898(ISS ≥ 21), each accompanied by an average 548% increase in gross charges. Costs also varied widely from $13,498 [IQR $8,247-26,254] to $45,759 [IQR $22,186-113,993] across TQIP patient cohorts. Of the total cost, 91% was attributed to personnel alone. Measuring the true cost of trauma care is feasible. As hypothesized, the true cost of trauma care is lower than charges. True cost increased with injury severity with variable cost across subgroups. Non-physician staff and administration are the largest component of the cost of trauma care.

Delayed dorsal scapular artery hematoma following blunt thoracic trauma: a case report and review of the literature

BackgroundThe present case contributes to the limited literature on delayed chest wall hematomas following blunt trauma. The literature review provides a summary of similar previously reported cases.Case presentationWe report the case of a 59-year-old Caucasian male who presented to the emergency department with a rapidly expanding chest wall hematoma. Six weeks earlier, he had sustained multiple rib fractures and a pneumothorax after falling 4 m from a ladder. Computed tomography angiography was used to identify two sources of active bleeding on the left dorsal scapular artery. The patient underwent surgery with evacuation of the hematoma and ligation of the artery. The patient was hospitalized for 3 days and recovered with no sequelae.ConclusionsA literature review revealed eight previously reported cases of chest wall hematomas exterior to the endothoracic fascia following blunt trauma. Most cases were initially diagnosed by computed tomography of the chest and finally by angiogram. Management options range from surgical drainage to angiographic embolization. This case is unusual regarding the delay in the development of the hematoma and illustrates the importance of considering this diagnosis even weeks after relevant trauma.