Gunshot Wounds Research Articles

Lower leg shortening technique in treatment of the wounded with gunshot tibial fractures

Background. The severity of gunshot wounds to the extremities is due to the formation of bone and soft tissue defects. The relevance of this publication is determined by the need to introduce simple and effective methods into the practice of providing assistance to the wounded. The technique under consideration fully satisfies these requirements. The aims of the study: 1) to optimize the lower leg shortening technique and analyze the short-term results of its application in treatment of the wounded with gunshot tibial fractures; 2) to assess the indications for surgical restoration of the lower leg length after its shortening. Methods. The study enrolled 45 wounded patients with gunshot fractures of the lower leg bones. Reconstructive interventions were performed on 51 segments. In the absence of purulent-necrotic lesions of the fragments ends, closed reduction and convergence to tight contact without resection were performed (13 cases, group I). In the case of necrosis of the fragments ends, resection and convergence were performed with significant shortening of the segment (38 cases, group II). Results. The amount of shortening accounted for 4 cm [3; 6] in group I and 8 cm [7; 10] in group II (p0.001). Due to the convergence of the fragments, the reduction of the soft tissue defect was 25 cm2 [11; 41] and 38 cm2 [20; 81] in group I and II respectively. In 2 (15.4%) patients in group I and 4 (10.5%) patients in group II no fusion occurred. In the remaining cases the fusion occurred, the consolidation period was 50 [45; 59] weeks in group I and 36.5 [29; 43] weeks in group II (p0.001). Conclusions. Depending on the condition of fragments ends, there are two possible options of the shortening technique: without resection and with resection of the fragments ends. Shortening without resection is possible in the absence of signs of fragment necrosis. The disadvantage is the risk of delayed fusion, the advantage is the ability to avoid traumatic intervention in the form of resection of the fragments ends. In case of the fragments ends necrosis, their transverse resection and convergence with the elimination of diastasis between them is necessary. The advantage of this shortening technique is the optimization of conditions and reduction of fusion time, the disadvantage is the formation of significant bone defects. The need for lengthening of the shortened segment does not always arise. Lengthening as a second stage after conducting rehabilitation is considered as an optimal choice.

Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.

Background: The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.Methods: Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.Results: Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, P = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.Conclusion: Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

Intraoperative oximetry of hollow organs in case of gunshot injuries of the abdomen

Intraoperative oximetry of hollow organs in case of gunshot injuries of the abdomen

Endovascular Repair in Patients with Axillary-Subclavian Arterial Trauma

Arterial trauma of the axillary subclavian segment carries considerable morbidity and mortality risks. Surgical approaches are challenging given the hidden trajectory of these vessels which has made the endovascular approach a valid -and potentially better- alternative for managing these injuries. We describe the incidence of relevant outcomes for patients with traumatic axillary and/or subclavian artery injury who underwent endovascular therapy at a tertiary care-university hospital over a 15-year period in Cali, Colombia. We conducted an incidence study based on clinical records that included patients aged 15 years or older with traumatic axillary subclavian arterial injury treated with endovascular therapy between 2008 and 2022. Vascular injuries caused by intra-arterial dialysis catheter insertion (iatrogenic) were excluded. We described clinical and imaging characteristics upon admission, perioperative findings, and the incidence of complications and in-hospital mortality, with accompanying 95% confidence intervals. We included 32 patients, 93.8% of whom were male, with a median (IQR) age of 30 (21-42) years. The type of trauma was penetrating in 75% of patients (62.5% corresponding to gunshot wounds) and blunt in 25%. Upon admission, 12 patients (37.5%) exhibited hard signs of vascular injury, and 20 patients (62.5%) exhibited soft signs. Fourteen patients (47%) had an Injury Severity Score (ISS) greater than 15 and 12 (37.5%) had hemodynamic instability. All but three patients (90.6%) suffered subclavian artery injury (right 48.3%, left 51.7%), while 12.9% had axillary artery injury (one patient with both vessels affected). Intraoperative complications happened in one patient (3.1%, 95%CI: 0.2%-18%). Pseudoaneurysms were identified in 11 patients (34.4%), thrombosis in 6 (18.8%), and dissection in 6 (18.8%). Three (9.4%) patients required hybrid management (endovascular therapy following conventional surgery). No cases of ischemia or amputation occurred. The length of hospital stay was 6 (3, 11.5) days. No cases of in-hospital mortality were reported (0%, 95% CI: 0.0-13.4%). Endovascular treatment in trauma is a minimally invasive technique with favorable clinical outcomes in patients with arterial trauma in the axillary-subclavian segment. This should be a viable therapeutic option for selected cases.

Military-Civilian Partnership to Improve Combat Casualty Care Readiness Among Non-physician Providers.

Military-civilian partnerships (MCP) provide a bidirectional exchange of information and trauma best practices. In 2021, Penn Presbyterian Medical Center and the U.S. Navy signed a 3-year memorandum of understanding to embed active duty trauma providers into the Trauma Division to facilitate the training and sustainment of combat casualty care (CCC) skills. To date, there is little evidence to demonstrate the efficacy of military-civilian partnerships in maintaining combat casualty readiness in non-physician trauma providers. We evaluated the impact of combat casualty readiness for non-physician providers by mapping clinical experiences in an urban Level I trauma center against the Defense Health Agency's Joint Trauma Systems (JTS) Clinical Practice Guidelines (CPG). The JTS CPGs provide best practices for CCCand highlight the critical skills providers need to know before deploying to an austere environment. Patient acuity data and specific JTS CPG skills performed by a non-physician providers were collected in their respective specialties for each patient seen between January 2023 to January 2024. Analyses were performed using descriptive statistics via Redcap. A sample of 6 Navy personnel in different specialties: 1 Physician Assistant, 3 Registered Nurses (emergency medicine, perioperative, critical care), and 2 corpsmen (scrub tech and search & rescue/prehospital medic) completed 1299 records on patients treated. In all, 685 (52.7%) were trauma patients and 614 (47.3%) were non-trauma patients. Categories of injuries seen, listed from the most frequent to the least, were as follows: Other (764), Falls (250), Motor Vehicle Crashes (164), Gunshot Wound (126), Stab-related injuries (41). Category 1 skills, defined as "essential to know," were performed in 921 (36.1%) of the patients treated. In Category 2, skills described as "important to know" were performed in 889 (34.8%) of the patients treated. Category 3 skills, identified as "less urgent" as they are rare among trauma patients, were performed in 486 (19.0%) of the patients treated, and 252 (9.8%) required none of the JTS CPG skills. These categories were further broken down based on the frequency of the skills performed. Analysis revealed strengths and identified opportunities to direct clinical experience for underperforming skills. Military-civilian partnerships support CCC readiness. The data presented and the continuation of mapping personnel's clinical experience to military CPGs can gauge readiness in non-physician trauma providers. Notably, several skills in each category were identified as opportunities to modify the clinical exposure of the military provider. These findings indicate that modifications in clinical assignments could enhance active duty combat casualty readiness in these critical skills.

Maxillo-orbital gunshot trauma in a pediatric patient

Gunshot injuries to the maxillofacial region vary in severity from minor harm to critical situations necessitating urgent medical intervention. Effective handling of facial gunshot wounds mandates a multidisciplinary approach to deliver thorough care to the individual.We present a pediatric patient presenting to the Emergency Department following an accidental machine gun injury.

Risk factors for fracture-related infections after low-velocity gunshot fractures to the pelvis

BackgroundAlthough treatments have improved dramatically in recent years, mortality following gunshot wounds (GSW) to the pelvis continue to range between 3 and 20 %. This project was designed to determine the incidence and risk factors associated with pelvic fracture-related infection (FRI) following GSWs to the pelvis given the paucity of evidence regarding this complication. MethodsA retrospective review of 13 years (1/2010–12/2022) of patients with GSW to the pelvis was performed. Patients meeting inclusion criteria underwent chart review for the development of pelvic FRI and the following additional data elements were extracted: demographics, presence and type of bowel injury, operations performed, complications, use of postoperative antibiotics (≤24 h vs. >24 h), surgical osseous debridement, presence of retained bullet fragments, and bullet trajectory. Discrete variables were analyzed using Wilcoxon rank-sum test, chi-square, and Fischer's exact test. Pearson correlation coefficients were calculated for continuous variables. Results242 patients were included in the study. Concomitant bowel injury was present in 108 patients (45 %). Eleven patients (4.5 %) developed FRI, all of whom had a concomitant bowel injury (p < 0.001). Neither the presence of retained bullet fragments nor the bullet trajectory (through bowel before the bone) was associated with FRI. Antibiotic duration >24 h was not associated with a lower rate of pelvic FRI. ConclusionDevelopment of FRI after a GSW to the pelvis occurs in 4.5 % of patients and is significantly associated with concomitant bowel injury, specifically colonic injury. These findings can be used to help guide further studies on the role of prophylactic antibiotics or other strategies to prevent pelvic FRI.

The role of computed tomography angiography and digital subtraction angiography in the diagnosis and management of gunshot wounds to the head

Introduction: Traumatic intracranial pseudoaneurysms (TICAs) and penetrating cerebrovascular injuries (PCVI) complicate gunshot wounds to the head (GSWH) and other forms of penetrating traumatic brain injury (pTBI). Recent developments in neuroimaging have allowed early detection of these lesions in the minutes and hours following the initial injury. CT angiography (CTA) and digitally subtracted angiography (DSA) have different sensitivity, periprocedural risks, and logistical limitations. Growing evidence is defining their role in clinical practice. Methods: A systematic review of the literature was performed for published articles treating the use of CTA and DSA to diagnose PCVI and TICAs after pTBI and GSWH. Four series, three retrospective and one prospective, were selected for this review. Results: In three retrospective and one prospective series (with a sensitivity of ~70% in the former studies vs 36% in the latter), DSA emerges as the modality of choice to study the intracranial vasculature of patients that suffered pTBI. Nonetheless, the use of CTA in the first hours after the injury can provide a wealth of information in emergent scenarios where TICAs and PCVIs can significantly affect surgical management and risk. Further, a significantly higher incidence of TICAs was reported in the first hours after civilian GSWH via CTA. Conclusions: DSA and CTA emerged as two complementary techniques in the study and management of PCVI and TICA related to pTBI and GSWH. Their integration can provide a safe approach to the emergent surgical management of vascular lesions via CTA, allowing for delayed DSA characterization after neurological and hemodynamical stabilization.

Divide and Save: A Critical Care Air Transport Team Case With Prolonged Field Care

ABSTRACT Critical care air transport teams (CCATTs) specialize in providing intensive medical and postoperative resuscitative care during air evacuations. In a 2014 mission, a seasoned CCATT was urgently deployed to evacuate 6 American service members with gunshot wounds. Despite only having 2 hours of premission preparation and no further injury or treatment details, CCATT secured additional equipment, medications, and blood supply. Upon arrival to a foreign nonmilitary hospital, they discovered that American ground commanders had lost trust in local medical capabilities. One patient experienced prolonged extremity tourniquet time and surgical delay. This led to acute renal failure, preventing immediate evacuation without continuous renal replacement therapy (CRRT). Deviating from the standard procedure, the CCATT obtained permission to split their team. The CCATT nurse attended 5 stabilized patients during unregulated critical care air transport with plans to swiftly return with CRRT equipment for the critical sixth patient. The physician and respiratory therapist remained at the foreign hospital for 2 days to provide prolonged field care. This case demonstrates the evolving mission scope of CCATT, which may encompass ground triage, prolonged field care, unregulated movement, and atypical CCATT equipment such as CRRT, occasionally necessitating a split team construct. To adapt to these evolving needs, updated policies and training now incorporate these diverse CCATT concepts, emphasizing the importance of flexibility in en route critical care missions.

Renal artery projectile embolus after cardiac gunshot injury: interventional retrieval

Renal artery projectile embolus after cardiac gunshot injury: interventional retrieval

Comparative analysis of the healing dynamics in gunshot versus domestic purulent-infected wounds

Aim. To conduct a comparative analysis of the dynamics of healing of gunshot and domestic wounds in the purulent-infected stage, depending on the wound coating used.Methods. The study examined the treatment outcomes of 30 patients with gunshot and household purulent-infected soft tissue wounds, treated during a special operation in the Donetsk region of Donbass. Among these patients, those with gunshot wounds were military personnel involved in active combat. The gender distribution was 7 women (23 %) and 23 men (77 %), with a mean age of 42.5 years [range: 33.59 to 75 years]. The average Body Mass Index (BMI) of the patients was 27 kg/ m² [range: 25.35 to 28.15 kg/m²].Results. When comparing the patient groups, notable differences in wound healing rates were observed. The group with the highest healing rate showed significant progress, with wounds healing by 80.7 % by day 15 and 95.8 % by day 30. Another group, which underwent a similar treatment method, also demonstrated a high healing rate, albeit slightly lower: by day 15, wounds had healed by 71.6 % (3.1 % lower than the first group), and by day 30, the healing rate was 93.7 % (2.1 % lower). The groups with the lowest healing rates showed significantly slower progress, with healing rates of 52 % and 47.9 % on day 15, and 87 % and 81.5 % on day 30, respectively

Gunshot Injury With Bone Defect of the First Metatarsal Bone A Presentation of 2 Cases Treated With an Iliac Crest Structural Graft, Internal Fixation, and Bone Morphogenic Protein 2.

Gunshot injuries to the foot with segmental bone defects can be challenging to treat. When the vascularity is intact and the soft tissues allows, the goal should be to reconstruct the bony defect. We present 2 cases of a gunshot injury to the foot with a defect of the first metatarsal bone. Both cases were treated, with favorable outcome, with a structural iliac crest graft, internal fixation, and bone morphogenic protein 2.Level of Evidence: V, cases series, technical.

Bilateral decompressive craniectomy as a damage control strategy for a preschooler multilobar bihemispheric firearm injury: a case report and systematic review.

The absence of guidelines for managing gunshot wounds to the head (GSWH) with bihemispheric lesions in pediatric patients highlights the need for prompt and diverse damage control strategies. This article aims to systematically evaluate the evidence surrounding the management of GSWH in preschoolers and to report a novel approach. We present a case of a 4-year-old girl who sustained a gunshot wound to the left parietal region. She was admitted to a level 1 trauma center 90min post-injury with stable vital signs, a Glasgow coma scale (GCS) of 12 (E3, V3, M6), and grade III hemiparesis in her right upper limb. Initial surgical management included left hematoma decompression and right frontotemporoparietal decompressive hemicraniectomy in two stages under the same anesthesia. Due to massive brain swelling during the left-sided procedure, it was converted to a left frontotemporoparietal decompressive hemicraniectomy. Both procedures included autologous pericranium augmentation duraplasty and watertight suturing. A right-side decompressive hemicraniectomy followed without exploring bullet lodging, using bilateral Kempe incisions. Bone flaps were stored under cryopreservation. During a 30-day hospital stay, neurological assessments showed a gradual recovery of right upper limb strength to grade IV + , with no other deficits or operative complications. Postoperative CT scans at 7, 14, and 28days showed minor pseudomeningoceles and a reduction of intraparenchymal edema. Multidisciplinary care continued throughout the stay. The patient showed no signs of endocrinological, infectious, or residual neurological issues and underwent bilateral autologous cranioplasty on day 35. She was discharged on day 38 with a GCS extended of 8 (full recovery/minor deficits not affecting daily activities) and minor right upper limb apraxia. A systematic review identified nine patients under 6years old with GSWH, with only one previously reported case of a 3-year-old patient with bihemispheric lesions undergoing bilateral craniectomies and achieving positive outcomes. Our case and the review suggest that bilateral decompressive hemicraniectomy is a feasible strategy for managing multilobar bihemispheric GSWH in preschoolers. However, the evidence of management for this population remains of low quality, highlighting the need for further research, and justifying this case report.

Hybrid 1 randomized controlled trial of an integrated stepped-care mental health intervention for traumatic injury patients

BackgroundAnnually, nearly 3 million individuals in the US are hospitalized after experiencing a traumatic injury (e.g., serious automobile crash, gunshot wound, stab injury). Many traumatically injured patients experience a trajectory of resilience. However, 20–40 % develop mental health problems such as posttraumatic stress disorder and depression; population estimates exceed 600,000 patients annually. Most trauma centers do not provide direct services to address mental health recovery, but the 2022 American College of Surgeons guidelines have established this as a priority. Cost-effective interventions are needed that meet the needs of patients at each stage of the recovery process while achieving sustainability at the level of implementation. This protocol paper describes a study that rigorously tests the Trauma Resilience and Recovery Program (TRRP), a scalable, sustainable technology-enhanced intervention to support the mental health recovery of patients who have experienced a traumatic injury. MethodsWe describe a randomized controlled trial with 1-year follow up of TRRP vs. enhanced usual care with 350 traumatically injured patients, including recruitment and retention procedures, assessment, implementation and fidelity monitoring, and statistical plans. ConclusionNovel components of our design include integration of technology-based elements, use of a stepped-care model, and implementation in a trauma center that did not previously have a mental health program. Data collected address the impact of TRRP and inform improvements to the model and its implementation in preparation for large-scale testing and implementation initiatives. This body of work is critical to informing the field as it continues to move toward national standards and recommendations.Trial registration:NCT05497115Clinicaltrials.gov

The Impact of Area Deprivation Index, Geography, and Mechanism on Incidence of Ballistic Injury to the Upper Extremity.

This study investigates the intersection of ballistic injuries, geography, and Area Deprivation Index (ADI). We hypothesized that both ADI and geography are correlated with incidence of upper extremity ballistic injuries. Further, we characterize and compare 2 distinct upper extremity gunshot injury populations presenting to our institution: those sustaining violent ballistic injuries and those who suffer an accidental, self-inflicted injury. Our purpose is to evaluate the impact of geography and ADI on the pattern of upper extremity gunshot injuries in Illinois and Missouri. This was a retrospective review of adult patients sustaining ballistic injury to the upper extremity at a single urban level I trauma center over 10 years (n = 797). Seven hundred thirty patients had home addresses in Illinois or Missouri; these addresses were geocoded and included for analysis. Mechanism of injury was self-reported. ADI was measured from the 2019 Neighborhood Atlas, in which deprivation increases from 1 to 100. Comparisons between groups were conducted with unpaired t tests, Fisher exact test, or χ2 testing, where appropriate. Addresses constituted 259 unique census tracts, and the average number of upper extremity gunshot wound incidents per tract was 3, with a maximum of 22; 15.4% of census block tracts made up almost half (48.4%) of the total ballistic injuries in the study period; 97.7% of violent injuries occurred in Urban areas, as compared with only 60% of accidental injuries (P < 0.05). ADI and incidence of upper extremity ballistic injury were positively correlated. ADI varied significantly between patients sustaining violent (median, 94; mean, 86.1) versus accidental self-inflicted (median, 79; mean, 70.9) injuries (P < 0.05). Fifty percent of violent injuries in our data set occurred in block groups from the 2 most deprived quintiles. Upper extremity gunshot wounds in general are concentrated in census blocks with high ADI. Violent injuries in particular are more likely to occur in urban areas with high ADI, whereas patients with accidental, self-inflicted injuries are more geographically and socioeconomically diverse. These differing populations require unique approaches to reduce incidence and morbidity.

The Value of Less-Lethal Weapons

&lt;p class="MsoNormal" style="text-align: justify;"&gt;&lt;span lang="EN-US" style="font-size: 14pt; font-family: 'times new roman', times, serif;"&gt;Less-Lethal Weapons, including electric Tasers, velocity-reduction bullet-capture projectiles, rubber bullets, beanbag rounds, and other less-lethal projectiles used in police departments, federal and local law enforcement agencies, and military policing operations, as well as for private use, are topics of significant debate in recent years. These weapons can reduce collateral damage, reputational risk, and legal exposure while preventing wrongful and unnecessary deaths caused by conventional bullet wounds. Yet, opponents have highlighted concerns regarding the safety and effectiveness of these weapons, as well as their potential to cause injury or even death. While the primary duty of law enforcement officials is to preserve order and execute the law while protecting individual rights, they ultimately achieve these goals by exercising their coercive authority. Society expects police officers to rely on their professional training and judgment when using physical force to defend citizens and themselves or to apprehend criminal suspects. Because police officers must occasionally participate in physical acts of coercion, it is unavoidable that some of these interactions may result in bodily injuries to individuals, including the officers themselves. These injuries have real costs, such as medical treatment, lost wages, municipal liability, court claims and settlements, riots, and legal or even criminal exposure, as well as less-tangible collateral costs, such as the erosion of police legitimacy and public trust, which are more difficult to quantify but arguably more influential in shaping long-term public perceptions than personal injuries alone. Less lethal technology eliminates some of the concerns raised by lethal weaponry. This study reviews the advantages and disadvantages of these less-lethal weapon technologies versus traditional firearms for use by the police force, federal agencies, and military police while also performing advanced analytics to model the valuation and return on investment for a law enforcement organization implementing such technologies.&lt;/span&gt;&lt;/p&gt;

B - 53 Neuropsychological Functioning after a Bi-Parietal Penetrating Traumatic Brain Injury in a 28-Year-Old Hispanic Male

Abstract Objective In the U.S. there are approximately 115,000 non-fatal firearm injuries each year, resulting in an annual cost of over $229 billion. Of these injuries, some result in penetrating brain injuries where an object enters and lodges within the cranial cavity, with the severity of damage determined by the shape, mass, and energy released of the projectile as it passes through the brain. This case follows a 28-year-old right-handed Hispanic male with no premorbid medical history, 16 years of education, who experienced bi-parietal lesions as a result of a gunshot wound to the head one year prior. This trajectory is rare, with little literature detailing the effects of penetrating injuries to both parietal lobes. Method The gunshot wound resulted in a bullet trajectory from the left frontoparietal region to the right parietal calvarium with multiple displaced ballistic fragments. Since the injury, he presented with resolving right-sided weakness and sensory changes, reduced balance, memory complaints, and bilateral parietally mediated findings. Results Neuropsychological testing showed right-sided suppression (tactile, auditory, and visual in the lower quadrant), reduced sensation in his right hand, alexia with agraphia, acquired apraxia of speech without aphasia, Gerstmann’s Syndrome, topographical disorientation, visuospatial dysgnosia, and constructional apraxia. There was also indication of inattentiveness, memory impairments, and processing speed deficits. Conclusions The present case study delineates the neuropsychological sequalae after a penetrating brain injury to the right parietal lobe and left frontoparietal region, resulting in significant cognitive deficits consistent with pronounced bilateral parietal lobe findings.

Forensic-radiological diagnosis of gunshot wounds

Although gunshot wounds are less common in Germany than in other countries, aproportion of suicides and violent crimes are committed with firearms, which is why basic knowledge of diagnosis is important. Fundamentals regarding forensic assessment of gunshot wounds are discussed alongside typical radiological findings. In addition to analyzing our own cases and evaluating official statistics, this article is based on adiscussion of basic research and expert recommendations. The article describes the characteristics of the bullet entry and exit as well as special features of the bullet trajectory, particularly in bony injuries, and discusses their significance for radiological findings. Pitfalls in interpretation, such as changes in body position and the deflection of projectile (fragments) in the body, are presented, as are the advantages of supplementary radiological diagnostics (projectile search before initiation of dissection, simple detection of an air embolism, clarity of bullet trajectory reconstruction). This article is intended to provide an overview of not only typical types of weapons and projectiles but also their effects on the body of the victim, which must be documented by the examiner.

The psychosocial impacts of the 15 March terrorist attack on the Christchurch Muslim community: A descriptive, cross-sectional assessment.

On 15 March 2019, a white supremacist terrorist carried out sequential attacks on two mosques in Christchurch, New Zealand during Friday prayers. This resulted in the loss of 51 lives, 40 others sustained gunshot injuries, and there were approximately 250 survivors. This study aimed to evaluate the impacts on community members, assess clinical needs, facilitate access to appropriate interventions and provide insights into working with a traumatised and diverse population. This cross-sectional study used semi-structured clinical interviews and self-report measures to assess social and demographic factors, mental health disorders and well-being for adult Muslims 11-32 months post-attack. A total of 189 participants completed assessments. The sample was diverse, representing 34 different ethnicities and participant proximity to the attack was complex, with personal and familial exposures. Elevated levels of psychological distress and psychopathology were found with 38% of participants reporting moderate/severe psychological distress on the Kessler-10, 39% reporting post-traumatic stress disorder on the post-traumatic stress disorder checklist-5, and 40% reporting poor well-being or possible depression on the World Health Organization-5 Well Being Index. Secondary stressors were also documented, as well as high scores for post-traumatic growth and the importance of faith. This study provides valuable insights into the repercussions of the Christchurch mosque attack on the affected community, describing the complexity of exposure and the substantial burden of morbidity experienced. It also highlights the high levels of social connectedness and the role of faith in promoting positive outcomes in the recovery process for this population.

Chronic pain and psychological well-being in soldiers wounded during Russo-Ukrainian war

Background: Chronic pain is highly prevalent among Ukrainian soldiers with gunshot and mine-explosive injuries. Our study examines the impact of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) on chronic pain development and its effect on soldiers' quality of life post-treatment. Methods: In this retrospective study, we analyzed data from 1,166 wounded soldiers diagnosed with PTSD following ASR. We assessed pain intensity, anxiety/depression, quality of life, and PTSD presence at hospital discharge, one and three months later. Results: We identified significant predictors of chronic pain in wounded soldiers, emphasizing the role of psychological factors and the quality of life. High levels of anxiety and depression, PTSD symptoms, and low quality of life scores were strongly associated with chronic pain, even after adjusting for injury type and initial pain intensity. The presence of an ASR, high Hospital Anxiety and Depression Scale scores (HADS), and low scores on the Chaban Quality of Life Questionnaire (CQLS) were identified as predictors of chronic pain, with a notably high risk (95.6%) for patients meeting these criteria. Our findings suggest a significant association between the risk of chronic pain and ASR, with quality of life scores at discharge, one month, and three months post-treatment, indicating a high predictive accuracy. Moreover, ineffective pain treatment correlated with ineffective PTSD treatment. Conclusion: Soldiers' diminished psychological well-being post-gunshot and mine-explosive injuries significantly increase chronic pain risk. Addressing anxiety, depression, and PTSD symptoms, alongside improving quality of life, could reduce the likelihood of chronic pain and other negative health outcomes in soldiers with combat injuries.