Pattern Of Trauma Research Articles

Patterns of toxic stress and trauma for pediatric Hematopoietic Stem Cell Transplantation (HSCT): creating a model of responsive intervention

Background It is well documented that invasive medical treatment, such as Hematopoietic Stem Cell Transplant (HSCT), can be stressful and potentially traumatic for children, leading to Post Traumatic Stress Disorder (PTSD) or Post Traumatic Stress Symptoms (PTSS) after treatment. Despite this evidence, little is known about the patterns of stress and trauma that develop throughout the HSCT admission. Purpose To examine patterns of toxic stress and trauma that develop throughout the pediatric HSCT admission and understand how music therapists, as members of the interdisciplinary psychosocial care team, may proactively intervene to mitigate the impact of traumatic experiences. Method A two-phase retrospective longitudinal multi-case design was used with a combination of time series and template analyses. Sample The sample included 14 pediatric patients (aged 0–17) undergoing HSCT at a large pediatric hospital in the Midwestern United States. Findings The results were identifiable patterns of toxic stress and trauma and a model of care for music therapy that is responsive to the identified patterns.

Patterns of Familial and Racial Trauma and Their Associations with Substance Use Disorders among Racial/Ethnic Minority Adults.

Racial/ethnic minorities in the United States often experience many different types of traumatic events. We examine the patterns of familial and racial trauma and their associations with substance use disorders (SUDs) among racial/ethnic minority adults. We used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III. The study sample included 17,115 individuals who were Hispanic (43.6%), Black (34.9%), Asian American and Pacific Islander (17.0%), and American Indian or Alaska Native (AI/AN, 4.6%). Latent class analysis models with covariates and distal outcomes were analyzed to investigate patterns of trauma exposure and estimate binary outcomes of SUDs. Familial and racial trauma was measured by ten areas of adverse childhood experiences (ACEs) and six items of racial discrimination. We found four distinctive groups: low trauma (Class 1, 62.1%), high discrimination (Class 2, 17.2%), high ACEs (Class 2, 14.9%), and high trauma (Class 4, 5.9%). Compared to Class 1, other groups were more likely to include Black and AI/AN adults. Participants in Class 2 reported greater risks for alcohol and other drug use disorders. Those in Class 3 and 4 reported greater risks for alcohol, opioid, stimulant, and other drug use disorders. Given a higher risk of trauma exposure in Black and AI/AN adults, racially and ethnically sensitive trauma-focused interventions may help prevent and reduce SUDs in those populations.

A Changing Trend in Pattern of Maxillofacial Trauma in Mumbai: A Prospective Study.

Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries & to correlate the aetiology and pattern of facial injury. This prospective study includes 304 patients with facial trauma, who reported to our institute within a time span of 2 years. Data were collected on basis of sociodemographic status plus additional data obtained on type of injury, aetiology, location and status of the victim. The most frequent cause of maxillofacial trauma (MFT) was fall (43.3%) followed by RTA (34.2%) and assault (15.1%). In upper 3rd face region frontal bone fracture was prevalent with 1.3%, while in the midface, zygomatic complex (ZMC) fracture (3.9%) and in lower 3rd part of face, mandible fracture (42.8%) and dentoalveolar fracture (30.2%). Mandible was the most prevalent site for trauma. Although fall was the main aetiological factor in our study, midfacial injuries were mainly due to assault and RTA. Combination of mandibular fracture and soft tissue injury were mainly seen in RTA and injury due to fall. Conservative management was mainly employed for treatment with 46.1% followed by ORIF with 36.2%. Changing trend in aetiology of MFT was noted. Furthermore, study should be conducted for better understanding, and to carry out preventive measure for the same.

Black/African Americans Experience Disparate Outcomes after Lower Extremity Orthopaedic Injury Evaluation in U.S. Emergency Departments

Category: Trauma; Other Introduction/Purpose: Racial and ethnic disparities remain a major problem in orthopaedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopaedic lower extremity trauma (LET) in the U.S. over the last 10 years, as well as differences in final disposition outcomes. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for all orthopaedic LET presenting to U.S Emergency Departments (ED) from 2010–2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups at the population level. To compare outcomes specifically among patients with LET, adjusted odds ratios (aOR) were calculated for each racial/ethnic group using multivariate logistic regression. Results: Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the ten-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years) (Figure 1). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% CI: 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (aOR 2.15 [95% CI: 1.78– 2.59]) (Figure 2). By 2019–2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged AMA (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusion: Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Improved patient education and more effective communication may help ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes and reducing mortality.

Interpersonal violence in colonial era in Papua, Indonesia: A case study of trauma patterns of a Biak individual

AbstractIn many world regions, conflict resulting from power struggles can lead to interpersonal violence. In the recent colonial past, tribes in Papua and Papua New Guinea engaged in war and raiding that resulted in interpersonal violence, abduction, slavery, and casualties. This case study focuses on the analysis of a colonial period individual from Biak Island, Papua, Indonesia, using a biocultural approach. Only the cranium was available for analysis. Standard osteological methods were used to determine that the individual was likely a young to mid‐aged (26‐ to 42‐year‐old) adult female. Skeletal lesion type and patterning were observed macroscopically with digital photography and a newly developed ultraviolet light photography technique. Multiple sharp force trauma injuries were identified on the frontal, temporal, and occipital bones of the cranium. Interpreting the pattern of trauma within the context of the colonial period in Papua, it is suggested that this female individual may have been murdered, possibly as a slave taken during tribal warfare. This report is a significant resource for future bioarchaeological studies in Papua as it provides one of the only accounts of skeletal trauma during the colonial period in the region.

Clinical epidemiology pattern of orthopedic trauma during the COVID-19 pandemic: A multicenter study (Dr. Hasan Sadikin General Hospital and Ulin General Hospital)

Link of Video Abstract: https://youtu.be/JRX2wJWFCKs Introduction: COVID-19 has had profound implications on global healthcare systems, and this pandemic management has led to a significant change in orthopedic surgical activity. We aimed to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future. Methods: Descriptive observational cross-sectional study from Dr. Hasan Sadikin General Hospital and Ulin General Hospital was conducted from electronic medical records between January 2018 and December 2022. Analysis was performed using SPSS version 26 on descriptive analysis using mean, frequency, percentage, and standard deviation. Results: 2890 patients were enrolled for the current cohort, from 2018 until 2022, with predominantly male (n = 2117). Even though, an increase in overall admission from 2018 (n = 631) to 2019 (n = 784), a decrease after that occurred during the COVID-19 pandemic, which is from 2020, 2021, and 2022 (n = 652, 500, and 323, respectively) Conclusion: Knowing the number of fractures can be a tool to evaluate the types and incidence of fractures treated during the pandemic to provide insight into the situations for which orthopedic trauma surgeons should be prepared in unusual circumstances that may arise in the future.

Etiological factors and patterns of maxillofacial trauma among school-going children: A cross-sectional study at Khyber College of Dentistry, Peshawar

Maxillofacial trauma, such as superficial cuts and bruises, lacerations, and facial bone fractures, is a common health concern in youngsters. In this cross-sectional study, we sought to determine the prevalence and pattern of maxillofacial trauma in school-aged children (5 to 16 years) with a history of trauma. The study was conducted at the oral and maxillofacial surgery department, Khyber College of Dentistry, Peshawar. We excluded firearm injuries and maxillofacial trauma older than 15 days, whether treated or untreated, from the study. We enrolled 153 schoolchildren of both genders consecutively using non-probability sampling. To determine the etiology and nature of the trauma, we did radiographic confirmation utilizing many imaging modalities and comprehensive clinical assessments of the craniofacial region. The data was analyzed using SPSS version 22.0. The results of our study indicate that falls are the leading cause of maxillofacial injuries among school-aged children. A total of 52 (16.3%) of the patients had maxillary fractures, 30 (19.6%) had mandibular fractures, 30 (19.6%) had zygomatic-maxillary complex fractures, 23 (15%) had dentoalveolar injuries, and 45 (29.4%) had soft tissue injuries. In our study, soft tissue injuries were most prevalent among school-aged children, followed by mandibular, zygomatic-maxillary complex, and maxillary fractures. To investigate the pattern and etiology of maxillofacial injuries, we stratified the data by age, gender, and kind of school. Our findings may aid in developing effective strategies for preventing and managing maxillofacial trauma in school-aged children. These findings emphasize the necessity for focused interventions to reduce the frequency of maxillofacial trauma among school-aged children.

Frequency of mandibular fractures in children presenting with maxillofacial trauma.

Objective: To determine the frequency of mandibular fractures in children presenting with maxillofacial trauma. Study Design: Cross Sectional. Setting: Department of Oral and Maxillofacial, Ayub Dental Section at Ayub Teaching Hospital, Abbottabad. Period: 05 December 2018 to 05 June 2019. Material & Methods: A total number of 166 children from both genders between the ages of 1-12 years with a history of trauma to mandible were added to the study through consecutive non-probability sampling. All the particulars of these patients like age, gender, date of trauma, cause of trauma, pattern of trauma, associated injuries were noted down on a format designed for the study and X-rays of all the patients were taken. Results: The Mean±SDs of age in this study was 5.34+1.867. Out of these patients 96 (57.8%) were male while 70 (42.2%) were females. The results show that 66 (39.8%) patients had symphysis, 48 (29%) patients had parasymphysis, 32 (19.2%) patients had angle/body, 20 (12%) patients had condyle fractures. Associated injuries were also present in 103 (62%) patients. Conclusion: The most common type of mandibular fracture in children was symphysis followed by parasymphysis, angle/body and condyle fractures. Early identification and treatment of such pediatric mandibular fractures will help to minimize hospital stay thus reducing financial burden on patients.

The Trend of Change in Oral and Maxillofacial Injuries of Pediatric Patients in the COVID-19 Pandemic: a Regional Emergency Medical Center and Dental Hospital Study

The purpose of this study is to analyze changes in dental trauma in children under the age of 12 during the period of Coronavirus Disease 2019 (COVID-19). March 2020, when COVID-19 was officially declared a pandemic by the World Health Organization, was set as the starting point for COVID-19. From March 2018 to February 2020, subjects in the pre-COVID-19 period were classified as the Pre-COVID-19 group, and from March 2020 to March 2022, subjects in the post-COVID-19 period were classified as the COVID-19 group. Information related to trauma was collected through electronic medical records. The number of trauma patients before and after the outbreak of COVID-19 decreased significantly. During the COVID-19 period, there was no significant difference in the male-female ratio or the distribution order of age groups. In the COVID-19 group of permanent teeth, the ratio of trauma caused by personal mobility was higher than trauma caused by sports. In the COVID-19 group of permanent teeth, the ratio of crown fracture with pulp involvement was significantly higher than the ratio of crown fracture without pulp involvement. Changes in trauma patterns caused by COVID-19 were observed more clearly in school-aged children than in preschool children. In a pandemic situation such as COVID-19, it is expected to be used as a good educational basis for knowing that frequent diagnoses can change due to changes in the environment.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

The Impact of the COVID-19 Pandemic on the Pattern of Trauma Presenting to a Tertiary Care Trauma Centre in Oman.

This study aimed to investigate the change in the pattern of the presentation of trauma cases at the Sultan Qaboos University Hospital, before the COVID-19 pandemic and during its two waves/phases. This retrospective study was carried out from January 2019 to October 2021. Data on all trauma patients were collected from the hospital information system after ethics committee approval. The pattern of trauma was divided into paediatric, adult and geriatric age groups. The location of trauma was described as either outdoors, at home or on roads. This information was collected along with the details of the mechanism of trauma. Patients with incomplete data were excluded. Based on the inclusion criteria, 589 records were analysed. The mean age of presentation was 29 years. The majority were male (71%) with 54.2% adults, 34% paediatrics and 11.9% geriatrics. There was a gradual increase in the percentage of paediatric trauma during pre-COVID, COVID phase one and phase two, which were 29%, 32% and 51%, respectively. A significant decline (almost 50%) in the number of geriatric trauma cases was observed between pre-COVID and COVID phase two. Trauma at home increased by 65.9% during COVID phase two and penetrating trauma increased by 16.5% during COVID phase two. Intensive care unit admissions increased during the first phase of the pandemic by 10.5%. A significant change was found in the pattern of trauma cases before and during the COVID-19 pandemic. These observations could lead to better safety guidelines for the paediatric age group and steps could be taken to reduce penetrating trauma.

A retrospective comparative study of maxillofacial injury patterns caused by electric scooters and bicycles.

The emergence of shared stand-up electric scooters has led to an increase in their usage and, subsequently, an increase in the incidence of maxillofacial trauma. This study aimed to investigate the trauma pattern associated with the use of stand-up electric scooters compared with that related to the use of bicycles, which was a popular mode of personal mobility before the emergence of stand-up electric scooters. This study investigated the medical records of patients who visited Wonju Christian Hospital for maxillofacial trauma due to the use of stand-up electric scooter and bicycles between November 1, 2017 and October 31, 2022. Maxillofacial trauma was analyzed based on medical records, including those in the evaluation results of teeth, maxillofacial bones, and soft tissues. Crown fractures and tooth avulsions were observed more frequently with the use of stand-up electric scooters than with the use of bicycles. In contrast, crown-root fractures, tooth subluxation, and extrusive luxation were more commonly observed in bicycle riders. Additionally, the proportion of root fractures was similar between the two groups. However, no vertical root fractures were observed in patients who rode bicycles. The maxillofacial bone fracture rates between the two groups were similar, although the fracture patterns were different. The number of patients using stand-up electric scooters is increasing, and they are likely to have a worse prognosis compared with those using existing personal mobility devices.

Slaughtered like animals. Revealing the atrocities committed by the Nazis on captives at Treblinka I by skeletal trauma analysis

The infamous Treblinka camp was one of numerous extermination camps throughout Poland, where Germans carried out mass killings of Jews. There were two camps in Treblinka, AL Treblinka I, a forced labor camp, and KL Treblinka II, the site of the extermination camp. Treblinka I held captives of various origins and ethnic backgrounds who were serving their sentences by working in a pre-existing gravel pit. Many of those prisoners perished in the camp, and it was believed that the principal causes of their death were attributed to the horrific sanitary conditions in the camp as well as the strenuous hard work of daily life. In 2019, archaeologists uncovered a clandestine mass burial pit that contained commingled human skeleton remains at the Execution Site of the former Treblinka I camp. It was estimated that there were a minimum of forty-nine people in the pit. Within months, an anthropologist performed biological profile assessments and detailed trauma analysis on the recovered skeletal parts. The main goal was to study perimortem trauma patterns to infer the cause and manner of death of the victims. We hypothesized that the victims did not die solely because of the camps’ conditions but were brutally slaughtered by the camp guards. Our results were later compared with the survivors’ written testimonies. As a result of our research, we were able to show that the Treblinka I captives’ death was extremely brutal and that the killing methods were varied. This led us to conclude that multiple assailants were involved in the killing spree. All of our results were consistent with the written witness testimonies, which concurs with our skeletal material analysis that proves the atrocities committed by the Nazis on their civilian prisoners during the war took place.

The characteristics of mandibular fracture in Dr. Hasan Sadikin General Hospital Bandung, Indonesia

ABSTRACT 
 INTRODUCTION Mandibular fracture poses a fatal complication because the mandible plays an essential role in occlusion and aesthetics. The mandible is one of the bones most affected by facial fractures commonly resulting from trauma to the face and may be associated with severe morbidity and serious consequences METHODS The records of 282 patients referred to RSUP Dr. Hasan Sadikin General Hospital Bandung, Indonesia between January 2017 and January 2021 were analysed retrospectively. Data including age, sex, etiology of mandibular fracture, type of mandibular fracture, and treatment. Incompleted data from the medical record were excluded. 
 RESULTS Men aged 17-30 years were the most common victims of mandibular fracture. Road traffic accidents (RTAs) were responsible in 84% of cases. The most common anatomic site for mandibular fracture was parasymphysis region 28.7 with simple fractures 79%, and 82% of the total fractures were treated with open reduction 
 CONCLUSION The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations particularly by inexperienced young drivers.

Prevent, curtail and mitigate ocular injuries: Proposal for designing an eye injury registry model for the Indian Armed Forces

This article aims to propose a design for Eye Injury Registry (EIR) model for Indian Armed Forces, to make ophthalmologists and non-ophthalmologists aware about the existence as well as the usefulness of such a registry. This is a perspective study. The EIR model for Armed Forces was designed based on the relevant sources in PubMed, Scopus and Embase including registries of pioneering countries like United States and Canada. A questionnaire based on the model dimensions was developed (Cronbach's alpha>0.7) and filled by 04 senior ophthalmologists in Armed Forces, all of who had a significant experience in dealing with various types of ocular trauma, to give expert opinions, which were then applied to the proposed model to finalize it. In Armed Forces, a registry and reporting on eye injury along with a systematic collection of standard data on eye injuries will help ophthalmologists in the successful prevention. Such a registry and its large database once formed will permit elaborate epidemiologic investigations, highlighting preventable sources of injury, emerging patterns of trauma in our services, and the best possible treatment protocols to be adopted, for successful outcomes. EIR in Armed Forces can help in the collection of eye injury data, thereby improving the quality-of-care and expansion of prevention strategies for ocular injuries. It is a step to make a truly effective data bank, which will be instrumental in combating such preventable ocular injuries and in turn go a very long way in achieving the final goal of preventing up to 90% of such injuries.

Trauma and Injuries Pattern During Hajj, 1443 (2022): A Cross-Sectional Study.

Introduction Trauma and injuries are common among pilgrims during Hajj, the biggest mass gathering event. Trauma and injury causes vary from falling and pressing in crowdsto being burned by boiled water and road traffic accidents (RTA). Time to reach the hospitalduring highly condensed areasin Hajj are challenges for the public health authorities and the healthcare system to achieve optimum control, management, and outcome. This study aims to explore the pattern of trauma and injuries during Hajj as it is crucial to improve future preventive measures and care quality. Methods A cross-sectional questionnaire-based study was conducted in one hospitalin each of the Mena and Arafat (Al-Mashaar's areas) in Makkah City,Saudi Arabia, from July 8 to10, 2022. Data was collected through interviews with patients who visit the hospitals or enter the emergency department and are diagnosed with trauma or injuryduring the Hajj season of 1443 Hijri date (2022). Results A total of 264 people volunteered to participate in the survey. The mean age by years was 43.5 ± 10.7, and the majority (56%) were between 41 and 64.There were multiple nationalities - the most common nationality was Egyptian (25%), followed by Saudi (10%). The commonest type of trauma was cutting wounds (50%), and the commonest cause was falling (39%), followed by foot twisting (31%). There were 142 cases in Arafat and 122 cases in Mena in the study duration.Tissue contusions are higher in Arafat. Fractures (5%) were in both areas but higher in Mena with burns and sprains. Friction blister injuries were only in Menaand were statistically associated with walking barefoot (p<0.01), which was associated with Egyptians (p<0.05). Also, thigh chafingis only in Mena, while eye traumas and abrasion are only in Arafat. There were four causes of injury that are statistically significantly associated with the area (p<0.05): foot twisting in Arafat, pressing in overcrowding, stoning, and burning in Mena. Moreover, all the RTA cases (n=4) were in Arafat, and all the stoningand burning by boiling water were in Mena. Admission was only for burning (n=2) and falling (n=2) cases and only in Mena emergency hospital; otherwise, all trauma cases were discharged after receiving management - no deaths among the study sample.Injuries in Mena are likely to happen in the evening and night (n=91), while in Arafat, it is more likely intwo periods (n=113), in the early morning and afternoon. This difference is statistically significant between the two areas (p<0.05).Most pilgrims (n=129/253) reach the hospital in 16 to 30 minutes. A statistically significant association exists between the duration and the area (p<0.05). Most patients in Arafat (88%) reach the hospital in less than 30 minutes, while only 50% take the same duration in Mena. Conclusion The Hajj season of 1443 H (2022) has a similar trauma pattern and improved outcomes compared to previous seasons.Discovering and digging into the causes of traumas and injuries should be optimized in future research for better control and customized prevention measures. Establishing new and remodeling current prevention measures is recommended for more control.

Causes, Types and Management of Fracture of Dentate Region of Mandible

Aim: The mandible fracture ranks as the second most often occurring facial fracture. The advent of high-speed automobiles has led to a significant increase in the frequency of accidents in recent times. Mandibular fractures are observed as a notable occurrence of maxillofacial trauma in the region of Multan. Purpose: To determine the Causes, types and management of fracture of dentate region of mandible fracture. Method: The present research is an observational and descriptive investigation including a sample of 52 patients diagnosed with mandible fractures. The study was done at the Nishter Institute of Dentistry in Multan, Pakistan, spanning from September 2021 to February 2023. Following the endorsement of the research by the Ethical Review Board of the hospital, patients were recruited using a non-probability sequential sampling method. This research included patients who had a history of trauma and were admitted to Nishter Institute of Dentistry in Multan, Pakistan, as well as those from the surrounding districts of Multan. The assessment of mandibular fractures included doing extra-oral and intra-oral clinical evaluations, as well as obtaining panoramic and posterior-anterior radiographs of the mandible to establish a diagnosis. The data collected was then subjected to statistical analysis. Result: Among the sample of 52 individuals diagnosed with mandibular fractures, the age group of 21-30 years had the greatest proportion, with a notable male preponderance. The leading causes of fractures were road traffic accidents and assault, with the parasymphysis being the most often affected anatomical region. The occurrence and aetiology of mandibular fracture are indicative of the prevailing trauma patterns in a given population and may serve as a valuable resource for informing the development of initiatives aimed at mitigating and managing such injuries. Conclusions: Patients in the older age (51 years and over) exhibited a higher prevalence of fracture sites in comparison to patients in the younger age. This observation might perhaps be ascribed to the presence of a larger tooth-to-bone ratio. As a result, a decrease in bone density was seen among participants in the younger age category, whereas those in the older age category exhibited an elevation in bone frailty Keywords: Dentate fracture, mandible, trauma

Racial disparities in lower extremity orthopaedic injuries presenting to U.S. emergency departments from 2010 to 2020

Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. Materials and Methods The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Results Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusions Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. Level of Evidence III.

Study protocol for a randomised controlled trial investigating the effects of Mindfulness Based Stress Reduction on stress regulation and associated neurocognitive mechanisms in stressed university students: the MindRest study

BackgroundStress-related disorders are a growing public health concern. While stress is a natural and adaptive process, chronic exposure to stressors can lead to dysregulation and take a cumulative toll on physical and mental well-being. One approach to coping with stress and building resilience is through Mindfulness-Based Stress Reduction (MBSR). By understanding the neural mechanisms of MBSR, we can gain insight into how it reduces stress and what drives individual differences in treatment outcomes. This study aims to establish the clinical effects of MBSR on stress regulation in a population that is susceptible to develop stress-related disorders (i.e., university students with mild to high self-reported stress), to assess the role of large-scale brain networks in stress regulation changes induced by MBSR, and to identify who may benefit most from MBSR.MethodsThis study is a longitudinal two-arm randomised, wait-list controlled trial to investigate the effects of MBSR on a preselected, Dutch university student population with elevated stress levels. Clinical symptoms are measured at baseline, post-treatment, and three months after training. Our primary clinical symptom is perceived stress, with additional measures of depressive and anxiety symptoms, alcohol use, stress resilience, positive mental health, and stress reactivity in daily life. We investigate the effects of MBSR on stress regulation in terms of behaviour, self-report measures, physiology, and brain activity. Repetitive negative thinking, cognitive reactivity, emotional allowance, mindfulness skills, and self-compassion will be tested as potential mediating factors for the clinical effects of MBSR. Childhood trauma, personality traits and baseline brain activity patterns will be tested as potential moderators of the clinical outcomes.DiscussionThis study aims to provide valuable insights into the effectiveness of MBSR in reducing stress-related symptoms in a susceptible student population and crucially, to investigate its effects on stress regulation, and to identify who may benefit most from the intervention.Trial registrationRegistered on September 15, 2022, at clinicaltrials.gov, NCT05541263.

Penetrating combat-related thoracic trauma (review)

Objective — to study in detail the mechanisms and to investigate the imaging manifestations of combat-related penetrating thoracic injuries.&#x0D; Materials and methods. To perform the work, a literature search was provided according to the criterion «Thoracic penetrating combat-related trauma». 32 literary sources were selected for this request. Frag­ments of the clinical experience described in the literature according to the selected sources were illustrated by our own clinical cases of patients who were treated in Kharkiv medical institutions in 2022 for penetrating combat-related thoracic injuries.&#x0D; Results and discussion. Among victims who received chest injuries, polytrauma was most often diagnosed, complicated by several mechanisms of injury associated with penetrating, blunt, and explosive injuries. Pneumothorax and pulmonary contusion were the most common chest injuries. Thoracic injuries, thoracic vascular injuries, and lung ruptures were associated with the highest mortality rates, whereas pulmonary contusions, pneumothorax, and chest wall injuries were associated with relatively lower mortality rates. Chest X-ray is the first-line imaging method during the initial assessment of thoracic trauma in combat and non-combat situations. Such an examination is particularly important in polytrauma situations where multiple fatal injuries can be rapidly diagnosed in order to rapidly triage and include such an injury in the initial evaluation. Tension pneumothorax, large hemothorax, chest fragmentation, and some other lesions can be quickly diagnosed with a portable chest X-ray. Computed tomography (CT) of the chest is an important component of the comprehensive trauma evaluation, which allows to diagnose life-threatening injuries in hemodynamically stable patients with suspected multiple injuries not identified on chest X-ray. Chest CT detects 20 % more pathologies compared to chest X-ray.&#x0D; Conclusions. Combat-related thoracic trauma continues to be a significant contributor to the mortality rates of those injured in military operations. A clear injury pattern and atypical imaging manifestations of thoracic trauma are important to recognize at an early stage because of the acuteness of this category of patients and the impact of an accurate diagnosis on clinical management. Chest X-ray remains the main diagnostic tool. However, in modern and well-equipped institutions, chest CT, video-assisted thoracoscopy, and ultrasound scanning of the abdominal and chest cavity play an important role in the diagnosis of thoracic trauma. Quick and high-quality diagnosis and treatment are possible only in direct cooperation between surgeons and radiologists.