Trauma Victims Research Articles

RESTRIÇÃO DO MOVIMENTO DA COLUNA: UMA ANÁLISE DO CONHECIMENTO DOS PROFISSIONAIS DE ENFERMAGEM

ABSTRACT Objective: To analyze nursing professionals’ knowledge about restricting spinal movement in trauma victims and describe their decision-making. Method: An exploratory, descriptive, qualitative-quantitative study. A semi-structured interview was conducted with 27 nursing professionals from hospital and pre-hospital emergency services in São Leopoldo, Brazil, in March 2022. The data was analyzed using descriptive statistics and content analysis. Results: 48% of the professionals knew the current recommendations; most worked in pre-hospital care. Cervicalgia/lumbago was the predominant indication. In the category “decision making and the transition of care”, a lack of standardization in in-hospital conduct was identified, emphasizing the importance of sequence in care and trust between professionals. Final considerations: It was found that in-hospital teams had little knowledge of the current evidence, a lack of standardization in procedures, and difficulties in the transition of care between services.

The Impact of Gender on the Postoperative Consumption of Intensive and Intermediate Care Resources

Gender disparities when delivering healthcare are attributed to gender bias and gender-related pathophysiology. We examined the interaction of gender with the provision of postoperative intensive and intermediate care. Specifically whether for major surgeries, co-morbidities and lengths-of-surgery, women receive intensive and intermediate care as often as men. A two-phase prospective study performed in an Israeli university medical center explored utilization of postoperative intensive/intermediate care. Phase 1 examined gender differences in a broad range of postoperative intensive and intermediate patients. Phase 2 examined consecutive patients undergoing major abdominal and vascular surgeries to ascertain whether for similar surgeries and co-morbidities, women were as likely as men to receive intensive/intermediate care. Phase 1 ( n = 1883)—Proportionately more males were admitted to intensive/intermediate areas because they more often were trauma victims or had pre-existing ischemic heart disease. Female admissions were notable for obstetrical emergencies and post-meningioma excisions. Phase 2 ( n = 796)—The proportion of males and females receiving intensive/intermediate care did not differ after specific surgeries, for example, hepatectomy, carotid endarterectomy. However, among patients with underlying ischemic heart disease men, more often than women (15% vs. 21%, p < 0.05), received intensive care after elective surgery. Although pathophysiologic differences resulted in more men than women, receiving postoperative intensive/intermediate care, gender bias might also be operative. These observations highlight the importance of considering the influence of gender when choosing a postoperative care location to insure that gender differences in the levels of care are due to pathophysiology and not gender bias.

Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department.

This study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms. Using data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N=15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access. Fourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access. Adolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.

Socio-Demographic Profile of Patients Victims of Subaxial Cervical Spine Trauma at the University Hospital of Brazzaville (Congo)

Socio-Demographic Profile of Patients Victims of Subaxial Cervical Spine Trauma at the University Hospital of Brazzaville (Congo)

Firework-related ocular trauma in Pernambuco, Brazil.

This study aimed to describe the demographic and clinical characteristics of victims of fireworkrelated ocular trauma treated at the ophthalmologic emergency de partments of two reference centers in Pernambuco, Brazil, and to identify risk factors related to poor visual prognosis. We retrospectively evaluated the medical records of patients admitted in emergency departments with a report of firework-related trauma between January 2012 and December 2018. Data collected included patient's age, sex, place of origin, month and year of the accident, ocular structures affected, characteristics of the injuries, and type of treatment that patients received. For patients who were followed for >30 days, the final visual acuity and patient's origin were analyzed. Three hundred and seventy eyes from 314 patients were included, of which 248 (79.0%) were male and 160 (51.0%) were from the metropolitan region of Recife. The mean patient age was 25.6 ± 18.8 years. In 56 (17.8%) patients, the ocular trauma was bilateral. A total of 152 (48.4%) cases occurred in June. The most affected sites were the eyelids in 91 (24.6%) eyes and ocular surface in 252 (68.1%). Surgical treatment was required in 87 (23.5%) eyes. After clinical and surgical management, 37 (10.0%) eyes presented final visual acuity of <20/400. Of these, 34 (91.9%) eyes were from patients from the countryside or from another state. Patients from the countryside presented higher risk of developing blindness after a firework trauma than those from the metropolitan area (odds ratio of 5.46). Victims of firework-related ocular trauma were mostly male, from the metropolitan region of Pernambuco state and mainly pediatric patients or economically active. Those coming from the countryside and other states had higher risk of developing blindness.

Clinical-epidemiological evaluation of victims of thoracic trauma in a reference hospital in Aracaju-SE

RESUMO Introdução: o trauma torácico é definido como toda aquele que envolve a caixa torácica, arcabouço osteomuscular que aloja o coração, os pulmões, as pleuras e as estruturas do mediastino. Pode ser superficial ou causar risco de vida imediato às vítimas. No Brasil, a maioria dos atendimentos é decorrente da violência urbana. Objetivo: avaliar o aspecto clínico-epidemiológico dos pacientes vítimas de trauma torácico atendidos no Hospital de Urgência de Sergipe, Aracaju/SE, Brasil. Métodos: estudo transversal, observacional e prospectivo, realizado durante onze meses, com 100 pacientes politraumatizados. Formulário semiestruturado foi aplicado, e os dados sistematizados, analisados e testados estatisticamente considerando-se a margem de erro de 5%. Resultados: 85% dos pacientes eram do gênero masculino, com idade média de 39,3 e faixa etária de 30 a 49 anos; 57% deles possuíam ensino fundamental incompleto, 70% tinham renda familiar de até 2 salários mínimos e 41% eram provenientes da Grande Aracaju. Quanto ao mecanismo de trauma, 33% foi automobilístico, tendo como principal mecanismo o trauma contuso, e a principal consequência a fratura de arcos costais. Dentre os ferimentos penetrantes, os FAB (26%) e FAF (21%) foram os mais prevalentes, sendo o hemotórax sua principal consequência, sendo maioria dos pacientes submetida a toracostomia (59%). Conclusão: o perfil encontrado foi de homens, jovens, vítimas da violência urbana. A toracostomia foi resolutiva na maioria dos casos e deve ser instituída prontamente quando necessário. Uma menor parte dos pacientes necessitou de toracotomia, principalmente na presença de instabilidade hemodinâmica.

Injuries among children attributed to violence and social funding: a 10-year observational study

BackgroundMechanisms and patterns of injury in children are changing, with violent mechanisms becoming more prevalent over time. Government funding of services for children and young people has reduced nationally over...

Compassion fatigue among forensic medicine specialists in Türkiye: A cross-sectional study

Compassion fatigue explains the reduced caregiving capacity of healthcare workers as a consequence of repeated exposure to patients' suffering. It is aimed to evaluate compassion fatigue and factors affecting this situation in forensic medicine specialists who evaluate cases that are victims of permanent trauma due to their profession. Data collection forms including demographic data and a short compassion fatigue scale (SCFS) in healthcare workers were filled out online by volunteer forensic experts. 113 forensic experts participated. It was determined that participants' total SCFS score average was 36.86±21.01, secondary trauma sub-dimension average was 12.39±7.74, occupational burnout sub-dimension average was 24.47±14.52. The total mean score of SCFS of the participants who evaluated less sexual assault was statistically significantly higher. The total mean score of SCFS and the mean of occupational burnout sub-dimension of the participants who did autopsy were found to be statistically significantly lower. The occupational burnout sub-dimension average of those who performed autopsy above the monthly autopsy median value was found to be statistically significantly lower. Sub-dimension average of burnout of participants in the first five years of their professional life was found to be statistically significantly higher. It is noteworthy that total and sub-dimension average scores of forensic medicine specialists in Turkey are significantly lower than those of different professions, especially health workers, in different countries. While this may be an indication that occupational depersonalization has developed over the years among forensic medicine specialists in Turkey, especially those who evaluate autopsy and sexual assault cases, from a different perspective, it can be said that increasing professional experience and working in harmony with the education received have a positive effect on compassion fatigue and burnout.

Evaluation of the SEVERITY of FACIAL and GENERAL TRAUMA in child and adolescent victims of traffic accidents

•Evaluation of the FISS and TRISS SpO2 to obtain greater rigor in a standardized epidemiological profile of injury severity.•More accurate determination of trauma severity in child and adolescent victims of traffic accidents for improved urgency and emergency care.•Relation between the scales allows for better decisions on patient hospitalization, adequate treatment and the prevention of irreversible injuries.

Comparative analysis of the trauma care profile before and during the COVID-19 pandemic: a cross-sectional study in a tertiary university hospital.

to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.

First 10 days after the 6th of February 2023 earthquake disaster: experience of an orthopedic clinic on the border of the disaster zone.

The earthquake disaster that occurred on February 06, 2023, caused serious destruction and loss of life in the south of Türkiye. The purpose of this article consisting of two interconnected parts is to report the experience of our orthopedics clinic, which is located just on the border of the disaster area. The subject of the first part of the study is the characteristics of ortho-pedic traumas in earthquake victims and the treatment methods applied. The subject of the second part is the disaster work plan of the clinic and its consequences in practice. For the first step, descriptive information, diagnoses, and treatment methods of 204 earthquake victims who were treated by our clinic in the first 10 days after the disaster were compiled from the archives. In terms of the second phase of the study, an in-clinic work plan was created on the morning of the 1st day of the disaster. The teams and working hours in the emergency department, inpatient service, and operating room were determined. Hospital management and other clinics were contacted and hospital facilities were organized for orthopedic trauma victims. The mean age of the patients was 42.3 years. Among the age groups, the smallest group was children under 10 years old (6.4% of all patients). 132 of the patients had at least one fracture in 135 extremities. Most of the injuries involved the lower extrem-ity. 66 patients had crush injury with or without fracture. 181 orthopedic surgical procedures were performed in 144 patients. The most common operations were internal fracture fixation and debridement. The most used implant was the plate-screw combination. Thanks to the in-clinic work plan and the in-hospital assistance and allocation of facilities, we did not experience serious problems in the hospitalization, surgery, and post-operative follow-ups of the patients. Although we received numerous offers of assistance from external institutions, this was not possible due to bureaucratic obstacles. Among our most important problems were the shortage of sterilized powered surgical drills and the lack of a dynamic patient information database. Orthopedic clinics should prepare their in-clinic work plans for earthquake disasters and develop their facilities. In order not to encounter bureaucratic obstacles in emergency assistance, orthopedic clinics in different risk regions should be formally matched beforehand. A patient database table that clinical staff can access and revise using their smartphones facilitates the follow-up of large numbers of simultaneously hospitalized patients.

Epidemiological study of pediatric trauma in a reference hospital in Curitiba.

to analyze the prevalence of types of trauma, resulting injuries and managements in children and adolescents between 0 and 17 years old, treated in an Emergency Room in 2019. a retrospective cross-sectional descriptive study carried out by collecting data from medical records from January to December of 2019, encompassing pediatric trauma victims, divided according to age groups: infants (0-1 year), preschool children (2-4 years), school children (5-10 years) and adolescents (11-17 years). 3,741 patients records were included in the study. The search for assistance occurred spontaneously in about 70% of the cases and males were the most affected at all ages. In infants and preschoolers, the main mechanism of trauma was fall from heights, corresponding to 57.2% and 34.1%, respectively, whereas in school children and adolescents, the main mechanism was ground-level falls (38%) and sports trauma (22,3%), in this order. The main injuries presented, in general, were traumatic brain injury (28,2%), upper limb contusion (23,2%) and upper limb fractures (16,3%). the profile of the victims analyzed indicates the male sex as the most affected, with the trauma mechanism being the differential according to age. The most frequent mechanism is falls, more prevalent in infants and preschoolers, and the most common injury is extremity contusion, with the upper limbs being the most affected. In general, the cases were considered of low complexity, with a hospitalization rate of 6%.

Risk factors and current trends in maxillofacial trauma: An epidemiologic study at a major Trauma Center of North India

AbstractAimsThis study aimed to obtain an update on the epidemiologic data of maxillofacial injuries with an analysis of current aetiology and associated factors encountered at a major Tertiary Care Centre of North India.Materials and methodsThis retrospective study was conducted in a Tertiary Care Centre in Uttarakhand over 2 years. The demographics, aetiology, seatbelt/helmet use, alcohol consumption at the time of injury, site of the fracture, other associated injuries and type of intervention were recorded.ResultsThe male:female ratio was 4.2:1. A peak prevalence was found in the third decade (mean age 23.6). Road traffic accidents were the most common cause of trauma (76.9%). Maxillofacial injuries were higher in those who did not use a seatbelt or helmet (85.1%). Intoxication at the time of injury was a major factor, especially in accidents. Drivers were found to be injured more (74.7%) than pillion riders or passengers. The incidence of fractures was highest in monsoons (30%). Mandibular (37.8%) and zygomatic (20%) fractures were most commonly encountered. The most common site of mandibular fractures was parasymphysis (30.6%). Fractures were treated by open reduction and internal fixation. Concomitant neurological and orthopaedic injuries were common in patients sustaining maxillofacial injuries.ConclusionRoad traffic accidents continue to be responsible for maximum trauma. A multidisciplinary assessment of every trauma victim is essential. This study can help formulate rigorous injury preventive schemes by distinguishing and analysing maxillofacial trauma. Advocation and strict implementation of helmet and seatbelt use with a heavy penalty for drinking and driving can lead to the reduction of maxillofacial injuries.

A 3-year retrospective study of 866 children and adolescent outpatients followed in the Nice Pediatric Psychotrauma Center created after the 2016 mass terror attack.

The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0-18 years) who experienced traumatic events. This study describes the specificity of the care pathway for young trauma victims, with an explanation of how the NPPC works during the first three years. In this retrospective study, we conducted quantitative and qualitative data collection about new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. 866 children and adolescents were followed in the NPPC. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). A high number of children and adolescents impacted by the terrorist attack required follow-up consultations after exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.

Initial management of trauma victims

Trauma constitutes a large proportion of the number of lives lost, especially in the productive age group. Trauma-related deaths have a trimodal distribution: First, at site or on transfer due to severity of trauma injuries. The injury could be so severe that nothing can be done to save the life of that trauma victim. Second phase of deaths is usually due to hypovolaemia and are often treatable and avoidable. Timely and appropriate intervention at this stage can reduce the effects of trauma and prevent morbidity secondary to the injury. The third phase includes those patients who die of complications of trauma such as infection, embolism, sepsis, ARDS and septic shock. A well-managed second phase is likely to reduce the incidence of the third phase. A systematic approach to a victim of trauma is very necessary so that any life-threatening injury is not missed. The approach to trauma must be done in the following steps: Primary survey and resuscitation, secondary survey and definitive care. This article outlines the various steps of the initial management of trauma.

Qualité de vie apres un traumatisme grave de la main : a propos de 36 cas

Improve the quality of life of patients with severe hand trauma. A retrospective study was carried out from August, 1st, 2017, to May 31st, 2020, at the emergency department of a private clinic in Abidjan. Were included in this study all patients with severe hand trauma who had undergone emergency surgery with a quality-of-life assessment time of over six months after surgery. The data were reported on a structured and standardized survey form. We analyzed 36 patients, with average age of 38.6 years (min. 8, max. 71 years). The population study was predominantly male with a sex ratio of 17. 92% of patients were right-handed, and in 53% of cases, the trauma involved the dominant hand. 64.2% of the patients were manual workers. In 83.3% of the cases, the patients had no difficulty in writing. Patients had no difficulty in washing or drying their hair 88.9% of the time. Eighty-nine percent of the patients no longer felt pain. The patients didn't feel any weakness in the hand in 72.2% of the cases and in 63.9% of the cases there was no stiffness in the hand. Only 5.6% of the injured felt their health was poor and 83.3% of patients strongly disagree with feeling less valuable, less confident, or even less capable because of the trauma. 72% of patients were incapacitated for work between 5 and 15 weeks. 80.6% of trauma victims had no loss of income, and 88.9% of patients kept their previous jobs. 83.3% of patients did not experience any social discomfort. The patients had a good quality of life despite the severity of hand injuries they had due to early and adequate management combined with good physiotherapy.

Comparison of ultrasound with computed tomography to measure skeletal muscle mass in critically ill patients: A prospective study protocol

Therapy and nutritional status directly interfere in the clinical evolution of critically ill patients, in reducing morbidity and mortality, by maintaining the functional integrity of the gastrointestinal tract, decreasing the catabolic response, besides contributing to the reduction of hospitalization time resulting in less treatment cost. Critical patients and trauma victims suffer early changes in the quantity and quality of muscle mass. Tools to identify the groups most susceptible to these complications are necessary so that interventions can minimize the deleterious effects of malnutrition in critically ill patients. The aim of the present study is to measure muscle mass loss by measuring the thickness of the rectus femoris muscle by bedside ultrasound in critically ill patients admitted to the Intensive Care Unit (ICU) of a university hospital. Information will be collected regarding the length of hospital and ICU stay, the reason for admission, anthropometric data at admission and during hospitalization, energy needs, nutritional therapy used, and fasting time. This is a prospective, observational study that will be carried out in a single center in an ICU of a tertiary university hospital. The study population will undergo 3 tomographic images and 3 ultrasounds of the rectus femoris of each patient at different times. We propose, unprecedentedly, performing a validation study of ultrasound with the gold standard Computed tomography to evaluate the musculature of critically ill patients victims of traumatic brain injury. The results got will texto be fundamental for the development of new fields of investigation and certainly contribute to the discovery of a new approach to treat sarcopenia in critically ill patients. The Research Ethics Committee approved the study and all patients included will sign an informed consent form. (Clinical Record: RBR-2bzspnz).

Clinical profile and outcomes of trauma patients visiting the emergency department of a trauma center Addis Ababa, Ethiopia.

The term traumatic injury refers to physical injuries that present quickly and with a great deal of severity. These injuries can result from blunt, penetrating, and other causes. The best patients' outcomes are achieved when all parts of a trauma care system are in place. In low-resource settings, these facilities are scarce and their requirements high. Identifying patient profiles and evaluating these in relation to patient outcomes will help to guide interventions and monitor progress. This study aimed to examine the clinical profile and outcomes of trauma patients at ALERT Hospital, Ethiopia's busiest national trauma center. Aretrospective cross-sectional chartreview of 362 patients admitted fromJanuary 2019 to December 2019 at Alert Hospital trauma and emergency department was conducted. The male-to-female ratio was 2.5:1, with trauma more prevalent among those in the age group of 24-33. Comparatively more injuries 98 (27.1%) occur between 8 and 6 a.m. and 90 (24.9%) of patients were transported by ambulance to the hospital. Among patients referred to the hospital, 247 (68.2%) patients received pre-hospital treatment. Interpersonal Violence (IPV) accounts for 31.8% of all accidents, followed by Road Traffic Accidents (RTA), which account for 30.7%. The Kampala Trauma Severity score (KTS) II showed mild trauma (82.3%), moderate trauma (11%), and severe trauma account (6.6%). A total of 44.2% of the victims suffered soft tissue injuries and 24% suffered extremity fractures, with 11.3% sustaining polytrauma. The mortality rate was 3.6%, with RTA, head injury, polytrauma, the severity of the injury, and patients with CPR were statistically associated factors. IPV and RTA were the two most frequent causes of injuries, with most trauma victims being young. A great deal of emphasis needs to be given to preventing injury and improving prehospital emergency services.

Improving trauma victim monitoring on the field with new photopletysmography sensors

Improving trauma victim monitoring on the field with new photopletysmography sensors

The neglected epidemic of trauma from interpersonal violence against the elderly in South Africa

Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) managed at a major trauma centre in South Africa. This was a retrospective study on all patients who were aged > 65 years admitted to our trauma centre from January 2013 to December 2020, based in Pietermaritzburg, South Africa. Over the 8-year study period, 323 cases were included (62% male, mean age 72 years). Mechanism of injury: 80% blunt, 16% penetrating and 4% others. The median injury severity score (ISS) was 9. The median Charlson comorbidity index (CCI) for all 323 cases was 3. Diabetes (n = 53) was the most prevalent comorbidity which was followed by pulmonary disease (n = 23), cerebral vascular accidents (n = 16) and myocardial infarction (n = 15). Fifteen patients were on antiretroviral therapy (5%). Twenty-four per cent required surgical intervention. Eight per cent of cases experienced one or more complications. Twenty-five per cent (80/323) were related to IPV, 61% (49/80) of these were penetrating injuries and the remaining 31 cases were blunt injuries. Of the 49 cases of penetrating injuries, 33 were gunshot wounds (GSWs) and 16 were stab wounds (SWs) (1 GSW and 2 SWs were self-inflicted and were not included in IPV). Those cases that resulted from IPV were significantly more likely to require operative intervention, experience complications and longer lengths of hospital stay. Geriatric patients had poorer outcomes than non-geriatric patients and rural geriatric patients had worse outcomes than urban geriatric patients. Although the burden of geriatric trauma in South Africa appears to be relatively low, it is associated with significant morbidity and mortality. Trauma from interpersonal violence is especially common and is associated with significantly worse outcomes than that of non-interpersonal violence-related trauma. Elderly rural trauma victims have worse outcomes than their urban counterparts.