Survivors Of Traumatic Injury Research Articles

Association between the number of individuals injured in a traumatic event and posttraumatic stress disorder among hospitalized trauma patients.

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller-scale events (i.e., involving one or several injured persons)remains unclear. We conducted a registries-based study cross-referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2-4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long-term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2-4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events.

Resuming work roles after injury in a low-income context: Multiple factors influencing the return to work outcomes.

Return to work (RTW) is an important outcome indicator for the effectiveness of rehabilitation services, and the functional status and overall recovery among individuals who have experienced injury. Despite the rising incidence of traumatic injury among economically productive citizens in Ethiopia, there is a paucity of evidence about the RTW status of injury survivors. This study examined factors associated with RTW success and determinants of time to RTW after injury in Ethiopia. An institution-based cross-sectional study was conducted to collect data retrospectively one year after patients arrived at the study setting due to traumatic injuries. Medical records of all patients who visited the emergency room of a large public hospital in Addis Ababa were reviewed. Data were collected from survivors of traumatic injury, interviewed by telephone one year post-injury. Multivariable logistic regression and survival analysis were carried out to explore factors. Of the 251 participants, 75% were young adults (age </ = 39 years), 78% were male, 78% were urban residents, 41% were injured by road traffic collisions, and 59% returned to work within one year. The logistic regression model revealed short inpatient admission (AOR = 4.20; 95% CI: 2.10-8.50; p ≤ 0.001), no disability (AOR = 4.44; 95% CI: 2.10-9.60; p ≤ 0.001), motivation to RTW (AOR = 3.50; 95% CI: 1.61-7.50; p = 0.002), no chronic illness (AOR = 2.31; 95% CI: 1.14-4.70; p = 0.020), being in an administrative position (AOR = 5.32; 95% CI: 1.11-25.78; p = 0.038) and receiving injury compensation (AOR = 3.10; 95% CI: 1.22-7.73; p = 0.017) as factors for successful RTW within a year after injury. Further, the Cox regression analysis identified immediate access to healthcare after injury (AHR = 1.54; 95% CI: 1.05-2.25; p ≤ 0.026) and having injury of penetrative to internal organ, strain, sprain, dislocation or soft tissue (AHR = 1.81; 95% CI: 1.20-2.80; p = 0.007) as determinants of early RTW after traumatic injury. The study uncovers factors crucial to RTW planning and interventions, and provides insights to minimize barriers, foster a smooth transition to employment, and optimize survivors' lives after injury.

Post-discharge Outcomes and Healthcare Utilization Among Hispanic/Latinx Injury Survivors: English Language Proficiency Matters.

We sought to compare post-discharge outcomes and healthcare utilization between English-speaking non-Hispanic White (NHW), English-speaking Hispanic/Latinx (ESHL), and Spanish-speaking Hispanic/Latinx (SSHL) survivors of traumatic injury. While there is evidence of racial and ethnic disparities in healthcare utilization and post-discharge outcomes after injury, the role of English language proficiency in these disparities remains unclear. Moderate to severely injured adults from three level-1 trauma centers completed an interview in English or Spanish between 6-12 months post-injury to assess physical health-related quality of life (SF-12-PCS), return to work, and post-discharge healthcare utilization. The language used in the interview was used as a proxy for English-language proficiency, and participants were categorized as either NHW (reference), ESHL, or SSHL. Multivariable regression models estimated independent associations between language and race/ethnicity with SF-12-PCS, return to work, and post-discharge healthcare utilization outcomes. 3,304 injury survivors were followed: 2,977 (90%) NHW, 203 (6%) ESHL, and 124 (4%) SSHL. In adjusted analyses, no significant differences were observed between ESHL and NHW injury survivors for any outcomes at 6-12 months post-injury. However, SSHL injury survivors exhibited a lower mean SF-12-PCS (41.6 vs. 38.5), -3.07 (95% CI=-5.47, -0.66; P=0.012), decreased odds of returning to work (OR=0.47; CI=0.27 to 0.81; P=0.007), and were less likely to engage in non-injury related outpatient visits, such as primary care visits (OR=0.45; 95% CI 0.28, 0.73; P=0.001), compared to NHW patients. Hispanic/Latinx injury survivors have worse post-discharge outcomes and lower non-injury-related healthcare utilization than NHW if they have limited English-language proficiency. Addressing LEP-related barriers to care could help mitigate outcome and healthcare utilization disparities among Hispanic/Latinx injury survivors.

Differences in intestinal bacteria in traumatic injury survivors with and without probable posttraumatic stress disorder

BackgroundPosttraumatic stress disorder (PTSD) is a common consequence of traumatic injury, yet certain biological factors contributing to PTSD are poorly understood. The gut microbiome may influence mental health outcomes, but its role in heterogeneous PTSD presentations requires elucidation. MethodsBacterial composition was examined in adults 2–4 years post-trauma with probable PTSD (n = 24) versus trauma-exposed controls without probable PTSD (n = 24). 16S rRNA sequencing and bioinformatic tools assessed microbial diversity and abundance. Relationships between taxa and PTSD symptom clusters were evaluated. ResultsNo differences were found in overall microbial community structure between groups. The probable PTSD group exhibited significantly reduced Actinobacteriota and increased Verrucomicrobiota phylum abundance compared to controls. Specific taxa showed notable inverse associations with negative mood/cognition versus hyperarousal symptoms. Prevotella and Ruminococcaceae were negatively associated with negative mood but positively associated with hyperarousal. ConclusionsResults demonstrate microbial signatures of probable PTSD subtypes, highlighting the microbiome as a potential mediator of heterogeneous trauma psychopathology. Definition of PTSD microbial correlates provides a foundation for personalized psychobiotic interventions targeting predominant symptom profiles.

Psychosocial reintegration post-traumatic spinal cord injury in Rwanda: An exploratory study.

Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life. To assess psychosocial reintegration after TSCI in Rwanda. All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview. The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration. Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support. Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

Evaluating the Efficiency of Survey Collection Methods to Trauma Patients.

Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10. This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels. Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency. The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.

A qualitative longitudinal study of traumatic orthopaedic injury survivors’ experiences with pain and the long-term recovery trajectory

ObjectivesTo explore trauma patients’ experiences of the long-term recovery pathway during 18 months following hospital discharge.DesignLongitudinal qualitative study.Setting and participantsThirteen trauma patients with injuries associated with pain that had been...

Reported head trauma and odds of acute ischemic stroke or transient ischemic attack: A population-based study (NEDICES)

BackgroundSix previous observational studies have found a higher risk for stroke among traumatic head injury survivors. However, these studies have used record linkage systems, which could lead to underestimating stroke numbers. This study aims to reexamine the relationship between head trauma and the risk of ischemic stroke/transient ischemic attack (TIA) in an older population using data from the Neurological Disorders in Central Spain (NEDICES) study, a population-based study that includes rigorous clinical examinations for patients with suspected neurological diseases. MethodsWe asked participants if they had ever experienced head trauma that was severe enough to warrant a consult with a physician, leading, among others, to visiting the emergency room, hospitalization, or resulting in loss of consciousness. The history of head trauma was evaluated in 196 (5.7%) acute ischemic stroke/TIA cases and 3256 controls in the NEDICES study. ResultsAmong the final sample of 3452 participants, 354 (10.3%) subjects had a history of head trauma. Twenty-nine (14.8%) of 196 acute ischemic stroke/TIA cases vs. 325 (10.0%) of 3256 controls reported a history of head trauma (p = 0.039). In a regression analysis that adjusted for several variables (age in years, sex, educational level, ever smoker, ever drinker, diabetes mellitus, arterial hypertension, and heart disease), the odds ratio was 1.54 (95% CI = 1.02–2.35, p = 0.042). ConclusionsThe reported head injury was associated with a 54% higher probability of acute ischemic stroke/TIA. More research is needed to confirm these findings, especially using population-based longitudinal studies.

Assessment of Neuropsychological Impairment among Individuals with a History of Head Trauma – A Case-Control Analysis

Objective: To determine the frequency of different neuropsychological impairments in traumatic head injury survivors compared to those without a history of head trauma. Materials and Methods: A case-control study was done in Karachi, Pakistan, during February 2023 and March 2023, with participants aged 18 and above, of both genders, with or without a history of head trauma forming the case and control groups, respectively. Individuals with a history of head trauma or congenital neurological impairment were not included. Screening tools included the ESS, UNS, GAD-7 scale, and PHQ-9. Results: A total of 303 participants were enrolled, out of these 128 (42.2%) were in the case group and 175 (57.8%) were in the control group. The most common source of head injury was Road Traffic Accidents (53.9%, n = 69). 143 (63.8%) out of 224 males had a positive history of head trauma in their lifetime, making the male gender more susceptible. The majority who had a history of head trauma lie in the age group &lt; 21 years (52.6%, n = 110). No significant association was found between the interpretations of screening scales and history of head trauma. Conclusion: Traumatic head injuries and their long-term consequences can predispose a person to experience any cognitive impairment in their life. However, in this study, we could not find significant neuropsychiatric deficits in patients with a history of head trauma. Therefore, it is crucial to conduct further large-scale, multi-center, and controlled studies to explore the cognitive and psychological impairment associated with head trauma.

Neural processes of emotional conflict detection and prediction of posttraumatic stress disorder symptom clusters in traumatic injury survivors.

Given the prevalence and significant burden of posttraumatic stress disorder (PTSD), identifying early predictors of symptom development following trauma is critical. PTSD is a heterogeneous disorder comprised of distinct symptom clusters-reexperiencing, avoidance, negative mood, and hyperarousal-that contribute to the broad range of possible symptom profiles. Affective and attentional regulation processes, such as emotional conflict detection, are impaired in individuals with PTSD; however, the neural mechanisms underlying these alterations and their predictive utility for the development of PTSD symptoms remain unclear. Traumatic injury survivors (N = 49) without traumatic brain injury were recruited from the emergency department of an urban, Level-1 trauma center. Within 1 month of trauma exposure, participants completed a well-characterized emotional conflict task during a functional magnetic resonance imaging scan. Participants returned 6-month later for a clinical assessment of PTSD symptoms. Using a region-of-interest mask derived from whole-brain voxelwise analyses during emotional conflict detection (vs. no emotional conflict detection) we examined whether differential neural activity predicted 6-month PTSD symptom cluster severity. Greater activation of the right middle frontal gyrus during emotional conflict detection prospectively predicted lower PTSD avoidance symptom severity 6 months later (above and beyond the effects of self-reported baseline PTSD and depressive symptoms, previous traumatic life events, racial discrimination, age, sex, and injury severity). Neural processes of emotion conflict detection measured in the early aftermath of a potentially traumatic event are useful as predictors for the development of PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Neural Processes of Emotional Conflict Detection and Prediction of Posttraumatic Stress Disorder Symptom Clusters in Traumatic Injury Survivors

Supplemental Material for Neural Processes of Emotional Conflict Detection and Prediction of Posttraumatic Stress Disorder Symptom Clusters in Traumatic Injury Survivors

Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury.

Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service. This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up. Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals. Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery. Therapeutic/Care Management; Level IV.

92. Neural Processes of Emotional Conflict Monitoring and Prediction of PTSD Symptom Clusters in Traumatic Injury Survivors

92. Neural Processes of Emotional Conflict Monitoring and Prediction of PTSD Symptom Clusters in Traumatic Injury Survivors

Development and cross-validation of a veterans mental health risk factor screen.

VA primary care patients are routinely screened for current symptoms of PTSD, depression, and alcohol disorders, but many who screen positive do not engage in care. In addition to stigma about mental disorders and a high value on autonomy, some veterans may not seek care because of uncertainty about whether they need treatment to recover. A screen for mental health risk could provide an alternative motivation for patients to engage in care. Data from samples of veterans and traumatic injury survivors were analyzed to identify mental health risk factors that are characteristics of individuals or stressors or of post-trauma, post-deployment, or post-military service resources, experiences, or responses. Twelve risk factors were strongly related to PTSD (r > .50): current PTSD, depression, dissociation, negative thinking, and emotional lability symptoms, life stress, relationship stress, social constraints, and deployment experiences of a difficult environment, concerns about life and family, perceived threat, and moral injury. Items assessing each of these risk factors were selected and their validity to prospectively predict PTSD and/or depression 6 months later was assessed in a new sample of 232 VA primary care patients. Twelve items assessing dissociation, emotional lability, life stress, and moral injury correctly classified 86% of those who later had elevated PTSD and/or depression symptoms (sensitivity) and 75% of those whose later symptoms were not elevated (specificity). Performance was also very good for 110 veterans who identified as members of ethnic/racial minorities. Mental health status was prospectively predicted in VA primary care patients with high accuracy using a screen that is brief, easy to administer, score, and interpret, and fits well into VA's integrated primary care. When care is readily accessible, appealing to veterans, and not perceived as stigmatizing, information about mental health risk may result in higher rates of engagement than information about current mental disorder status.

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.

Providing rehabilitation services to major traumatic injury survivors in rural Australia: perspectives of rehabilitation practitioners and compensation claims managers

Purpose The delivery of healthcare services in rural locations can be challenging. From the perspectives of rural rehabilitation practitioners and compensation claims managers, this study explored the experience of providing and coordinating rehabilitation services for rural major traumatic injury survivors. Materials and Methods Semi-structured interviews with 14 rural rehabilitation practitioners and 10 compensation claims managers were transcribed, and reflexive thematic analysis was conducted. Results Six themes were identified (1) Challenges finding and connecting with rural services, (2) Factors relating to insurance claims management, (3) Managing the demand for services, (4) Good working relationships, (5) Limited training and support, and (6) Client resilience and community. System-related barriers included a lack of available search resources to find rural rehabilitation services, limited service/clinician availability and funding policies lacking the flexibility to meet rehabilitation needs in a rural context. Strong peer and interdisciplinary relationships were viewed as crucial facilitators, which rural practitioners were particularly adept at developing. Conclusions Greater consideration of unique needs within rural contexts is required when developing service delivery models. Specifically, flexible and equitable funding policies; facilitating interdisciplinary connections, support and training for rehabilitation practitioners and compensation claims managers; and harnessing clients’ resilience may improve the delivery of rural services. IMPLICATIONS FOR REHABILITATION Rural survivors of major traumatic injury often have ongoing health and rehabilitation needs and struggle to access required treatment services. Rehabilitation providers and compensation claims managers highlighted areas for improvement in rural areas, including resources for locating available services, funding the additional costs of rural service delivery, and greater service choice for clients. Building rural workforce capacity for treatment of major traumatic injury is needed, including improved clinician access to specialist training and support. Developing good working relationships between clients and clinicians, including interdisciplinary collaborations, and supporting client resilience and self-management should be promoted in future service delivery models.

A Qualitative Study to Understand the Impact of Caring for Traumatic Injury Survivors

Following traumatic injury, an informal carer is often required to support recovery. Understanding the impact of caregiving is important to inform intervention design. to explore the impact of caring on family and caregiver finances, employment, social life, and psychological wellbeing. Semi-structured interviews conducted with carers of traumatic injury survivors. Interviews were audio recorded, transcribed and thematically analysed, informed by the Roy Adaptation Model (RAM) and International Classification of Functioning, Disability and Health (ICF). Ten participants were interviewed. Key themes included (1) financial impact/employment issues, (2) relationships and support and (3) psychological impact. Most carers did not receive professional support with daily care post-discharge. Carers' employers responded positively, supporting them even after extensive leave. Carers received inconsistent communication whilst visiting trauma survivors in hospital; carers with healthcare experience were favoured. Navigating and receiving benefits was complex. Some carers found it difficult to accept the trauma survivor's injury, whilst others focused on achieving goals. Support from professional services is limited outside hospital settings for non-brain injuries. Future interventions and healthcare services should acknowledge the lack of psychological support for carers. Researchers should consider using the ICF/RAM when designing interventions to ensure the full impact on carers is addressed.

CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury

This article highlights the need to screen survivors of traumatic orthopedic injuries for postinjury symptoms associated with stressor-related disorders such as acute stress disorder and posttraumatic stress disorder, including pain, sleep disturbances, anxiety, and depression. The authors discuss the presentation of these postinjury symptoms, the instruments used to screen for each, the various pharmacological and nonpharmacological treatments, and the nursing implications for managing postinjury symptoms in traumatic orthopedic injury survivors.

Prevalence of Housing Insecurity in Survivors of Traumatic Injury.

Almost 20% of the US population are housing insecure (HI) due to inadequate living conditions, imbalanced costs to income, nonsustainable shelter, or overcrowding. Housing insecure and physical trauma share similar risk factors, but their direct association is not well elucidated. The objective of our study was to determine the prevalence of HI in survivors of traumatic injury. We conducted a prospective cohort study at an urban, level 1 trauma center. A survey on social determinants of health was administered to adult patients, and demographic, injury specifics, and clinical outcomes data were collected. HI was defined by affirmative answers to questions related to history of homelessness or concern about sustainable shelter. The cohort was stratified by HI; groups were compared using the Mann-Whitney U and Fisher exact tests, as appropriate. Of 116 study participants, four were excluded due to missing data. Of the 112, 42 (37.8%) reported HI and most were black (69%) males (73.8%). There were no demographic differences between groups. Conversely, HI patients had a higher rate of penetrating traumatic injury (34.1% vs 14.5%, P-value = .03) and were significantly less educated compared to secure participants (P-value = .03) [no degree (26.2% vs 10.3%), high school degrees (21.4% vs 41.2%)] with concomitant illicit drug use (63.4% vs 27.9%, P < .001), and history of addiction (52.4% vs 7.2%, P < .001). HI far exceeds national averages in our cohort. Although difficult to ascertain a cause-effect relationship, HI may be a modifiable risk factor for trauma that negatively influences outcomes.

Perspectives of major traumatic injury survivors on accessibility and quality of rehabilitation services in rural Australia

Purpose For the 30% of Australians who live in rural areas, access to rehabilitation services after sustaining a major traumatic injury can be challenging. This study aimed to explore the experience of rural major traumatic injury survivors accessing rehabilitation services. Materials and methods Semi-structured interviews were conducted with 21 rural major traumatic injury survivors (Mage = 47.86; SD = 11.35; Range: 21–61) who were an average of seven years post-injury (SD = 3.10; Range: 3.25–13.01). Transcribed interviews were thematically analysed. Results Four themes were identified: (1) Managing the transition back to local services, (2) Independence and determination to get better, (3) Rehabilitation is an ongoing process, and (4) Limited service access and quality. While injury-related symptoms persisted for many participants, they expressed strong determination for independence and self-management of their recovery. Barriers to accessing rehabilitation services included poor knowledge of local services, travel burden, financial costs, and a lack of local practitioners experienced in major traumatic injury rehabilitation. Facilitating factors included financial, psychological, community, and informal supports. Conclusions To support recovery, future rural service models should improve consideration of factors resulting from living at a distance to services and harness independence to self-manage. IMPLICATIONS FOR REHABILITATION Rural major traumatic injury survivors need support to navigate numerous barriers to accessing rehabilitation services. Rural participants expressed their preference for greater involvement in planning their transition back home following hospitalisation and help to link with available services in their local area. Specialist training and support for rural rehabilitation practitioners is needed, to effectively treat impairments related to major traumatic injury, particularly psychological and cognitive difficulties. Future service delivery models should incorporate methods to locate rural services; facilitate telehealth access and client self-management; and provide financial and mental health support to both rural survivors of major traumatic injury and their carers.