Trauma Research Research Articles

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey.

The National Academies of Sciences, Engineering, and Medicine 2016 report on the trauma care system recommended establishing a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded a study to generate a comprehensive research agenda spanning the trauma and burn care continuum. Panels were created to conduct a gap analysis and identify high-priority research questions. The National Trauma Research Action Plan panel reported here addressed trauma systems and informatics. Experts were recruited to identify current gaps in trauma systems research, generate research questions, and establish the priorities using an iterative Delphi survey approach from November 2019 through August 2020. Panelists were identified to ensure heterogeneity and generalizability, including military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: patient/population, intervention, compare/control, and outcome. In subsequent surveys, panelists prioritized each research question on a 9-point Likert scale, categorized as low-, medium-, and high-priority items. Consensus was defined as ≥60% agreement. Twenty-seven subject matter experts generated 570 research questions, of which 427 (75%) achieved the consensus threshold. Of the consensus reaching questions, 209 (49%) were rated high priority, 213 (50%) medium priority, and 5 (1%) low priority. Gaps in understanding the broad array of interventions were identified, including those related to health care infrastructure, technology products, education/training, resuscitation, and operative intervention. The prehospital phase of care was highlighted as an area needing focused research. This Delphi gap analysis of trauma systems and informatics research identified high-priority research questions that will help guide investigators and funding agencies in setting research priorities to continue to work toward Zero Preventable Deaths after trauma. Therapeutic/Care Management; Level IV.

Unprecedented Times in Journalism: Emotional Stress and Covering the COVID-19 Pandemic

ABSTRACT This study explored emotional distress and organizational support in the context of covering the COVID-19 pandemic. A survey of 222 local journalists in the US revealed covering the story was both stressful and emotionally difficult. Females and those who were younger and less experienced perceived higher levels of stress and felt the story was more emotionally difficult than their counterparts. Females also felt their supervisors were less emotionally supportive and less supportive of their attempts to balance home and work. Supervisor support of home/work balance was associated with less overall emotional stress from the story. The repetitive nature of the coverage, interacting with victims, and public backlash for their reporting were among the top stressors. Nearly 60% of participants indicated they received no stress management resources from their news organizations. Of those that did, most did not take advantage. Implications for organizational support and journalism and trauma research are discussed.

Supplemental Material for An Introduction to Directed Acyclic Graphs in Trauma Research

Supplemental Material for An Introduction to Directed Acyclic Graphs in Trauma Research

The incidence and impact of ‘Tandem Neurotrauma’

IntroductionThe epidemiology and prognosis of the isolated traumatic brain injury (TBI) and spinal cord injury (SCI) are well studied. However, the knowledge of the impact of concurrent neurotrauma is very limited. Research questionsTo characterize the longitudinal incidence of concurrent TBI and SCI and to investigate their combined impact on clinical care and outcomes, compared to a comparative but isolated SCI or TBI. Materials and methodsData from 167,793 patients in the Trauma Audit and Research Network (TARN) registry collected in England and Wales between 2008 and 2018 were analysed. Tandem neurotrauma was defined as patients with concurrent TBI and SCI. The patient with isolated TBI or SCI was matched to the patient with tandem neurotrauma using propensity scores. ResultsThe incidence of tandem neurotrauma increased tenfold between 2008 and 2018, from 0.21 to 2.21 per 100,000 person-years. Patients in the tandem neurotrauma group were more likely to require multiple surgeries, ICU admission, longer ICU and hospital LOS, higher 30-day mortality, and were more likely to be transferred to acute hospitals and rehabilitation or suffer death at discharge, compared to patients with isolated TBI. Likewise, individuals with tandem neurotrauma compared to those with isolated SCI had a higher tendency to receive more than one surgery, ICU admission, longer LOS for ICU and higher mortality either at 30-day follow-up or at discharge. Discussion and conclusionsThe incidence of tandem neurotrauma has increased steadily during the past decade. Its occurrence leads to greater mortality and care requirements, particularly when compared to TBI alone. Further investigations are warranted to improve outcomes in tandem neurotrauma.

Histopathological efficacy of tacrolimus in an experimental head trauma study.

This study aimed to investigate the protective effect of tacrolimus (FK506), an immunosuppressive agent, on secondary brain damage in rats with experimental head trauma. 40 Sprague-Dawley rats, aged 10-12 weeks and weighing 250-350 g, were used without gender selection. The subjects that were divided into five groups of 8 rats per group (sham control, negative control, positive control, vehicle control, and treatment) were sacrificed 1 month after head trauma was induced under appropriate conditions, their brains were then removed en bloc and evaluated histopathologically. Secondary brain injury was evaluated with the immunoreactive score (IRS) after Glial Fibrillary Acid Protein staining of gliosis that would occur in brain tissue. The evaluation of the histopathological IRS values of all groups showed significant statistical differences between all groups. The pairwise group comparison revealed the highest increase in IRS value in the treatment group (p<0.05), with no statistical significance despite the increase in the negative control, positive control, and vehicle control groups. The sham group had the lowest rate of severe histopathological reaction score. It was observed that the group treated with FK506 had a statistically significant increase in gliosis in the traumatic area compared to the other control groups. This shows that FK506 cannot prevent and even increase gliosis by a mechanism that has not yet been clarified. In conclusion, it is obvious that the FK506 immunosuppressive agent does not reduce post-traumatic brain injury; on the contrary, it increases gliosis.

Augmentation and Dissociation: Exploring Brain's Associations Across Real and Virtual Realities

This paper explores the malleable nature of perceived reality and bodily ownership as demonstrated through multisensory illusions like the rubber hand experiment. Research shows that precisely matching what someone sees and feels can recalibrate neural processing to incorporate fake limbs into one’s sense of bodily boundaries and agency. This means an individual's feelings of having a body and self come from the brain continually tweaking itself based on intersensory correlations. Meanwhile, extensive trauma research reveals significant disruptions when overwhelming experiences prevent smooth processing, storage and understanding in an individual. This manifests in dissociated fragments and dysfunctional encodings splitting from explicit memory and ownership, recreating persisting struggles without awareness. However, early therapeutic approaches using coordinated sensory stimulation suggest the potential for compassionately reshaping rigid implicit perceptions that complicate trauma recovery by tapping into neuroplasticity. Research on bodily illusions, the complexities of trauma, and sensory-based treatments shows that trauma can be framed as a disruption in aligning expectations with sensory input to create a more unified experience. There exists potential for tailored therapeutic exposures through custom sensory feedback to rewrite rigid encodings towards post-traumatic growth. Future research should thoughtfully explore these avenues into practical methods that respect survivors’ agency and dignity. Overall these themes reveal one's perception of reality as fluid, constructed by the brain continuously adjusting its predictions and interpretations to match the incoming flow of sensory information from sight, sound, touch, etc. Trauma strains the integrative system underlying a coherent experience. Therapies strategically recalibrating the senses can help realign stuck implicit perceptions of trauma. Through controlled and empowering sensory exposures, these therapies assimilate past overwhelming impressions into narratives that affirm bodily wholeness and resilience.

Traumatic spinal cord and spinal column injuries: A bibliometric analysis of the 200 most cited articles.

Bibliometric analysis. This study aimed to highlight the 200 most influential articles related to traumatic spinal cord and spinal column injuries and provide an insight of past and current global trends in spinal trauma research. The Web of Science database was used to identify the top 200 most cited articles on the topic of traumatic spinal cord injury (SCI) and spinal column injuries between using a prespecified algorithm. The articles were manually reviewed; bibliometrics were collected on title, first and corresponding authors' country, institution, journal, publication year, and citation data. The search string yielded 30,551 articles during 1977-2019. The average time from the publication was 19.5 years. A total of 1356 authors contributed to 67 different journals, the top 200 most cited articles amassing a total of 88,115 citations and an average 440.6 citations. The United States of America (USA) contributed the most with 110 articles; the top institution was the University of Toronto with 34 publications. Most studies focused on basic science research on SCI. Keyword analysis revealed the most commonly used keywords: SCI, inflammation, apoptosis, incidence/prevalence, and regeneration; four word-clusters were identified. Institutions from the USA and Canada collaborated the most and two major and two minor institutional collaboration subnetworks were identified. Co-citation analysis detected three main clusters of authors. This overview of the most cited articles on traumatic spinal cord and spinal column injuries provides insight into the international spinal trauma community and the terrain in this field, potentially acting as a springboard for further collaboration development.

Previous injury, sex and well-being are associated with injury profiles in 422 adolescent elite athletes of age 15–16 years: a 20-week longitudinal study

BackgroundAdolescent elite athletes have a high injury risk and many risk factors for injury have been suggested. However, there is a lack of prospective studies in adolescent elite athletes of...

A practical guide to random-effects Bayesian meta-analyses with application to the psychological trauma and suicide literature.

Bayesian meta-analyses offer several advantages over traditional approaches, including improved accuracy when using a small number of studies and enhanced estimation of heterogeneity. However, psychological trauma research has yet to see widespread adoption of these statistical methods, potentially due to researchers' unfamiliarity with the processes involved. The purpose of this article is to provide a practical tutorial for conducting random-effects Bayesian meta-analyses. Explanations and recommendations are provided for completing the primary steps of a Bayesian meta-analysis, ranging from model specification to interpretation of results. Furthermore, an illustrative example is used to demonstrate the application of each step. In the example, results are synthesized from six studies included in a previously published systematic review (Holliday et al., 2020), with a combined sample size of 21,244,109, examining the association between posttraumatic stress disorder and risk of suicide in veterans and military personnel. The posterior distributions for each model estimate, such as the pooled effect size and the heterogeneity parameter, are discussed and interpreted with regard to the probability of increased suicide risk. Our hope is that this tutorial, along with the provided data and code, facilitate the use of Bayesian meta-analyses in the study of psychological trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Division Trauma and Forgiveness

The primary goal of this thesis is to critically review studies that try to understand the historical experience of the division of the Korean peninsula and its development through trauma theory. It is judged that their study has a challenging aspect to the already known trauma research, but also has limitations and problems at the same time.&#x0D; Efforts to understand division in Korea have been developed in various academic fields. Therefore, this study, first of all, focuses on clarifying the differences between division trauma research and past division studies. To that end, this study will review the necessity of research on division trauma, which trauma researchers say, and identify the characteristics of understanding division violence they have, and also examine the characteristics of division trauma. In addition, this study will critically analyze the direction of healing from division trauma, which they prospect. The prospects for integrated narratives that overcome the narratives of division and the prospects for the restoration of national commonality will be the main targets of criticism. Finally, while comparing and crossing the understanding of forgiveness in the Bible and the prospects for healing by division trauma researchers, I will look for a direction in which division trauma research can be further deepened and expanded. Although it does not present a sufficient theological analysis, this study is part of a longer one to find the interface between Korea’s Minjung theology or peace theology and the study of division trauma.

Psychological Lynching: An Examination of Educational Trauma and Identity Development

This article seeks to shed light on the ways urban educational spaces aid in the traumatization of Black students and their identity formation. Educational spaces and experiences have continued to shape identity development for many individuals who encounter this contextual setting (Clayton, 2020; Leath et al., 2019). This article positions the theories of critical race (CRT) and racial space (RST) as a vehicle to more intentionally explore and link trauma work to discussions of identity development. In these spaces, identities are strengthened or disrupted, with implications for academic and social well-being. This study highlights the voices of eleven Hampton Roads, Virginia teachers. These teachers reflect and share their traumatic experiences and provide insight into how those experiences influenced their identity development. Additionally, this article contributes ideas for conducting identity-conscious trauma research and building race-conscious pathways for supporting trauma-exposed youth in urban educational spaces.

Transfer traumy. Monografia zbiorowa Літературний образ дитинства в часи кризи pod redakcją Katarzyny Jakubowskiej-Krawczyk

The text is a review of a collective monograph Літературний образ дитинства в часи кризи edited by Katarzyna Jakubowska-Krawczyk. The book is about the issues of childhood in times of crisis. Researchers from Poland and Ukraine analyze various issues, such as World War II, the Holocaust, the totalitarian regime, homelessness and the ongoing war in Donbas. The book uses the modern method of postcolonial studies and trauma research from the generational transfer perspec- tive. It deals with very important issues.

What factors are associated with loss of alignment after open reduction and internal fixation for tibial plateau fractures? A retrospective multicenter (TRON group) study

BackgroundTibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. MethodsThis multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. ResultsLA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02–1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00–1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). ConclusionsPreoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF.

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma.

On May 4 and 5, 2022, a meeting of multidisciplinary stakeholders in the prevention and treatment of venous thromboembolism (VTE) after trauma was convened by the Coalition for National Trauma Research, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and hosted by the American College of Surgeons in Chicago, Illinois. This consensus conference gathered more than 40 in-person and 80 virtual attendees, including trauma surgeons, other physicians, thrombosis experts, nurses, pharmacists, researchers, and patient advocates. The objectives of the meeting were twofold: (1) to review and summarize the present state of the scientific evidence regarding VTE prevention strategies in injured patients and (2) to develop consensus on future priorities in VTE prevention implementation and research gaps.To achieve these objectives, the first part of the conference consisted of talks from physician leaders, researchers, clinical champions, and patient advocates to summarize the current state of knowledge of VTE pathogenesis and prevention in patients with major injury. Video recordings of all talks and accompanying slides are freely available on the conference website ( https://www.nattrauma.org/research/research-policies-templates-guidelines/vte-conference/ ). Following this curriculum, the second part of the conference consisted of a series of small-group breakout sessions on topics potentially requiring future study. Through this process, research priorities were identified, and plans of action to develop and undertake future studies were defined.The 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma answered the National Trauma Research Action Plan call to define a course for future research into preventing thromboembolism after trauma. A multidisciplinary group of clinical champions, physicians, scientists, and patients delineated clear objectives for future investigation to address important, persistent key knowledge gaps. The series of papers from the conference outlines the consensus based on the current literature and a roadmap for research to answer these unanswered questions.

Feasibility of Capturing Orthopaedic Trauma Research Outcomes Using Personal Mobile Devices.

Patients with orthopaedic trauma are frequently lost to follow-up. Personal mobile devices have been used to ascertain clinical research outcomes. The prevalence of mobile device ownership, use patterns, and attitudes about research among patients with orthopaedic trauma would inform clinical research strategies in this population. A total of 1,434 consecutive unique adults scheduled for an orthopaedic trauma outpatient clinic from December 2019 through February 2020 at a metropolitan level 1 trauma center were identified. Associations of demographic data with clinic attendance and mobile phone registration were explored by logistic regression. One hundred one patients attending clinic were then prospectively surveyed from June 2021 through August 2021 about housing stability, personal mobile device ownership, capabilities, use patterns, and openness to communicating via the device with for orthopaedic care and research. The prevalence of personal mobile device ownership was 91% by registration data and 90% by a survey. Ninety-nine percent of survey respondents with mobile devices reported cell service always or most of the time. Ninety-three percent kept their devices charged always or most of the time. Ninety-two percent reported e-mail access. Eighty-three percent reported video capability. Ninety-one percent would communicate with their orthopaedic trauma care team by text message. Eighty-seven percent would answer research questions by phone call, 79% by text, and 61% by video. Eighty-five percent reported stable housing, which was not associated with mobile device ownership or use, but was associated with clinic nonattendance (29% vs. 66%, P < 0.01) and changing phone number at least once in the previous year (28% vs. 58%, P = 0.04). Personal mobile devices represent a feasible platform for screening and collecting outcomes from patients with orthopaedic trauma. Nine in 10 patients own personal mobile devices, keep them charged, have text and e-mail service, and would use the device to participate in research. Housing instability was not associated with mobile device ownership or use patterns.

EGS P01 The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people

Abstract Background There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods Data was retrieved for patients between 10–25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2015–2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time and mortality were analysed according to the hours of daylight, darkness and season. Results The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500–1630 correlating to school pick up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124) with moderate injuries (ISS 9–14) occurring most commonly during the day (72.7%) and more severe injuries (ISS&amp;gt;15) occurred during the night (55.8%). Conclusions We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role . This could be addressed through a targeted public health approach to implement change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.

Risk factors for injury and illness in youth floorball players – A prospective cohort study

ObjectivesTo investigate risk factors for injury and illness in female and male youth floorball players (12–17 years) during a 26-week floorball season. DesignProspective cohort study. SettingRecreational youth sport. Participants471 players (142 females) 12-17 years. Main outcome measuresWeekly survey including questions about stress, sleep quality, well-being, sport exposure and average weekly rating of perceived exertion (RPE). Acute:chronic workload ratio (ACWR) was calculated. The Oslo Sports Trauma Research Center questionnaire on health problems was used. Predictors of new injury and illness were examined using multi-level logistic regression models with weekly measures nested within individuals. ResultsHigher stress, poorer sleep quality and well-being increased the odds of a new injury in the subsequent week by 8% (2.0–13.5%), 10% (4.2–15.9%) and 8% (2.4–13.5%) per 1 unit increase. Higher stress, and poorer well-being increased the odds of illness by 8% (2.6–12.6%), and 12% (7.2–16.6%). ACWR below 0.8 or above 1.3 increased the odds of illness by 34% (4.9–70.8%). ConclusionsPerceived stress, well-being, and sleep quality were associated with injury and illness occurrence in the subsequent week. ACWR outside the range 0.8–1.3 was associated with illness the subsequent week. Trial registrationClinical Trials registration NCT03309904.

Impact of different cover letter information and incentives on Veterans’ emotional responses to an unsolicited mailed survey about military traumas: a randomized, 3x2x2 factorial trial

BackgroundAltering cover letter information to reduce non-response bias in trauma research could inadvertently leave survey participants unprepared for potentially upsetting questions. In an unsolicited, mailed survey, we assessed participants’ change in affect post-survey after altering key cover letter information and promising different incentives. We tested direct and indirect effects of participants carefully reading the cover letter on changes in their affect post-survey.MethodsIn a 3X2X2 randomized, factorial trial, 480 male and 480 female, nationally representative Veterans who were applying for posttraumatic stress disorder disability benefits were randomized to receive one of 12 different cover letters. The cover letters provided general versus more explicit information about the survey’s trauma content and how their names were selected for study; we also promised different incentives for returning the survey. The main outcome was change in affect post-survey. We examined five potential moderators: combat or military sexual trauma exposure, posttraumatic stress disorder or serious mental illness diagnosis, and recency of military service. Mediators between reading the cover letter carefully and post-survey affect included how participants rated the cover letters’ information and whether they thought the cover letters prepared them for the survey’s content. A Bonferroni corrected alpha of 0.003 was the threshold for statistical significance.ResultsOne hundred ninety men and 193 women reported their pre-and post-survey affect. Across all study conditions, out of 16 possible points, the net change in affect post-survey was less than a quarter-point for men and women. Mean changes in post-survey affect did not differ statistically significantly across any of the study factors (ps > 0.06); nor were there statistically significant interactions between any of the study factors and the 5 moderators after accounting for multiple comparisons (ps > 0.02). After controlling for pre-survey affect, reading the cover letter carefully had small effects on changes in post-survey affect, with larger associations seen in the women compared to men. Mediators’ effects were often in opposite directions for men and women.ConclusionGeneral descriptions of a survey’s trauma content appear ethically defensible. Research on cover letters’ impacts on survey participants’ emotional reactions and how those impacts differ by gender is needed.

Supplemental Material for Bayesian Analysis of Single Case Experimental Design Count Data in Trauma Research: A Tutorial

Supplemental Material for Bayesian Analysis of Single Case Experimental Design Count Data in Trauma Research: A Tutorial

Social vulnerability index and firearms: How neighborhood health disparities affect trauma outcomes

Firearm injuries’ association with individual-level socioeconomic risk is well described. Trauma research has suggested that neighborhood level risk factors may be associated with differences in firearm injury outcome. We analyzed the relationship between hospital length of stay (LOS), mortality and neighborhood level social markers from the Center for Disease Control (CDC) Social Vulnerability Index (SVI) after firearm injury. We used the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) in 2016 to identify firearm injuries using ICD-10 E-codes. Patient locations were identified at the census tract level. The 2016 CDC SVI was used to evaluate neighborhood level social vulnerability. Logistic and linear multivariable regression were used to evaluate the association between SVI percentile rank, mortality, and LOS. We identified 9,764 cases of firearm injury in our database; 88.2% of individuals were male, and the average age was 33.8 years. Assault was the most common intent, accounting for 4682 (48.0%) of all admissions. Overall, SVI was correlated with the risk of firearm injury, but not associated with either outcome of length of stay or risk of death. While there is significant disparity between SVI and risk of firearm injury, once admitted to the hospital outcomes are similar between low and high-vulnerable populations. To reduce disparities in risk, funding and effort should focus on primary prevention.