Trauma Victims Research Articles

When Bereavement Makes Enemies Human

Across the world, one common feature that unites societies suffering under violent conflict is the experience of trauma. Most commonly, this trauma is understood as a paralyzing force that inhibits its victims of thinking clearly and rationally, creating the need for others, mostly political elites representing these constituencies, to speak out in their place. By appropriating their constituencies’ trauma, then, political elites are enabled to instrumentalize it to legitimize their political goals, such as the perpetuation of the violent conflict itself. In this paper, however, I argue that trauma can also be a powerful source of agency for the traumatized, with the potential to transform them into agents with the capacity to create frameworks for peace. In examining the case of the Parents Circle/Families Forum (PC/FF), I show how the experience of trauma through the conflict enables the victims of trauma to understand the irrationality of the armed conflict, countering the political elite’s narrative and prompting them to promote a peaceful solution to the war. Furthermore, their efforts can be a powerful source of reconciliation by engaging across conflict lines, thus promoting both sympathy for and empathy with the supposed enemy.

Beyond donation to organ utilization in the USA.

The deceased donor organ pool has broadened beyond young, otherwise healthy head trauma victims. But an abundance of donated organs only benefits patients if they are accepted, expeditiously transported and actually transplanted. This review focuses on postdonation challenges and opportunities to increase the number of transplants through improved organ utilization. We build upon recently proposed changes in terminology for measuring organ utilization. Among organs recovered for transplant, the nonuse rate (NUR REC ) has risen above 25% for kidneys and pancreata. Among donors, the nonuse rate (NUR DON ) has risen to 40% for livers and exceeds 70% for thoracic organs. Programme-level variation in offer acceptance rates vastly exceeds variation in the traditional, 1-year survival benchmark. Key opportunities to boost utilization include donation after circulatory death and hepatitis C virus (HCV)+ organs; acute kidney injury and suboptimal biopsy kidneys; older and steatotic livers. Underutilization of less-than-ideal, yet transplant-worthy organs remains an obstacle to maximizing the impact of the U.S. transplant system. The increased risk of inferior posttransplant outcomes must always be weighed against the risks of remaining on the waitlist. Advanced perfusion technologies; tuning allocation systems for placement efficiency; and data-driven clinical decision support have the potential to increase utilization of medically complex organs.

The impact of post-encoding alcohol consumption on episodic memory recall and remember-know responses in heavy drinkers.

People often consume alcohol following trauma, particularly in response to distressing memories. To date, little is known about how post-encoding alcohol consumption influences episodic memory recall for negative events. Understanding these effects may help to improve support for trauma victims - for example, witnesses and victims of crimes. We tested 60 participants who self-described as heavy drinkers. After watching an analog trauma film, half were allocated to consuming a moderate dose of alcohol (Alcohol-Exposed group), while half received a placebo drink (Placebo-Control group). Immediately and after a one-week delay, participants recalled the event via free and cued recall tasks. Participants also gave remember-know responses and confidence ratings, elucidating alcohol's effect on experiential memory. Free recall performance was similar for the Alcohol-Exposed group and the Placebo-Control group during Sessions 1 and 2. The Alcohol-Exposed group benefitted more from the delayed repeated retrieval attempt. For the cued recall task, the Alcohol-Exposed group provided more "Do not Know" responses compared to the Placebo-Control group in both sessions. For the Alcohol-Exposed group only "Correct Know" responses increased from Session 1 to 2. Although memory performance improved across sessions, confidence levels decreased from Session 1 to 2 in the Alcohol-Exposed group. Post-encoding alcohol consumption appears to impact immediate episodic memory retrieval; however, this effect is only temporary in nature. No evidence was found that alcohol primarily reduces remembering responses. Much like previous findings focusing on pre-encoding alcohol consumption (Hagsand et al., 2017), current findings suggest that providing individuals who drank alcohol after witnessing an incident with a delayed repeated retrieval attempt can lead to more complete and accurate testimonies.

Assessing the Need for Transfer to a Trauma Center for Isolated Craniofacial Injury in a Rural State.

Management of craniofacial injuries typically defaults to plastic, ophthalmology, and oral maxillofacial surgeons which can challenge these surgical subspecialists' capacity to care for both trauma victims and non-trauma patients. Evaluating the need to transfer patients to a higher level of trauma care for isolated craniofacial injuries warrants investigation. Our 5-year retrospective study measured the frequency of craniofacial injuries and subsequent surgical interventions in elderly trauma patients' ≥65 years old. Eighty-one percent of patients consulted with plastic surgeons and 28% with ophthalmology. Twenty percent had craniofacial surgery with the majority of surgical interventions were in soft tissue (97%), mandible (48%), and Le Fort III (29%) injuries. A patient's ISS, GCS, head and face AIS, and presents of spinal or brain injury had no statistically significant impact on injury repair. Elderly patients with isolated craniofacial trauma may be better served by pretransfer consultation with a surgical subspecialist to determine the necessity.

Parents of children who are victims of trauma, allies or adversaries?

Introductiontrauma affects not the child but the whole family. how would the parents’ reaction to trauma influence the child’s resilience capacities?Objectivesstudy the mental health status of parents of children consulting the trauma and resilience unit.MethodsDescriptive and retrospective study of 20 consultants in the trauma and resilience unit at Mongi Slim hospital between January and April 2022. The evaluation of depressive symptoms in children was made by Children's Depression Inventory (CDI). The Hamilton Depression and Anxiety Scales were used to assess anxiety and depressive symptomatology in the parents of the consultants.ResultsThe mean age of the children was 10.46±3.24.The traumatic event was related to an assault in 75% of cases, 45% of which were intrafamilial, road accident and death of a relative in 10% respectively, 5% domestic violence.Five consultants had a CDI score ≥8 and 15 had a score >10. Only parents of children with a CDI score>19 had moderate to severe symptoms according to hamilton scales.The diagnosis of adjustment disorder was made in 45% of cases, post-traumatic stress disorder 20%, acute stress disorder 10% other 15%ConclusionsThe parents’ reaction to the tragedy would play a modulating role on the children’s resilience capacities. less anxious and depressed parents would help their child build his/her coping mecanisms.Disclosure of InterestNone Declared

Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study

BackgroundCricothyrotomy is a critical technique for rescue of the failed airway in the emergency department (ED). Since the adoption of video laryngoscopy, the incidence of rescue surgical airways (those performed after at least one unsuccessful orotracheal or nasotracheal intubation attempt), and the circumstances where they are attempted, has not been characterized. ObjectiveWe report the incidence and indications for rescue surgical airways using a multicenter observational registry. MethodsWe performed a retrospective analysis of rescue surgical airways in subjects ≥14 years of age. We describe patient, clinician, airway management, and outcome variables. ResultsOf 19,071 subjects in NEAR, 17,720 (92.9%) were ≥14 years old with at least one initial orotracheal or nasotracheal intubation attempt, 49 received a rescue surgical airway attempt, an incidence of 2.8 cases per 1000 (0.28% [95% confidence interval 0.21 to 0.37]). The median number of airway attempts prior to rescue surgical airways was 2 (interquartile range 1, 2). Twenty-five were in trauma victims (51.0% [36.5 to 65.4]), with neck trauma being the most common traumatic indication (n = 7, 14.3% [6.4 to 27.9]). ConclusionRescue surgical airways occurred infrequently in the ED (0.28% [0.21 to 0.37]), with approximately half performed due to a trauma indication. These results may have implications for surgical airway skill acquisition, maintenance, and experience.

Effects of hypobaric hypoxia during a simulated ultra-long-haul flight on inflammation and regeneration after muscle trauma and muscle trauma-hemorrhagic shock.

Because wounded warfighters or trauma victims may receive en route care to the closest medical facility via airplane transport, we investigated the effects of extended mild hypobaric hypoxia (HB), the environmental milieu of most airplanes, on inflammation and regeneration after muscle trauma or monotrauma (MT) and muscle trauma-hemorrhagic shock or polytrauma (PT). Male C57BL/6N mice were assigned to one of six groups pertaining to injury (control/uninjured, MT, and PT) and atmospheric pressure exposure (HB and normobaric normoxia, NB). Body mass, blood and muscle leukocyte number by flow cytometry, immunohistochemistry, or both, and the muscle relative mRNA level of selected genes involved in inflammation and muscle regeneration were examined at ~1.7, 4, 8, and 14 days post trauma (dpt). At 14 dpt, the proportion of smaller- and larger-sized myofibers at the regenerating site of MT mice was determined. Greater body mass loss, an increased number of blood and muscle leukocytes, and differential muscle relative mRNA levels were observed in MT and PT groups compared to controls. The MT+HB or PT+HB mice demonstrated more body mass loss and altered relative mRNA level than the corresponding NB mice. Additionally, a subgroup of MT+HB mice demonstrated a greater proportion of smaller myofibers (250 to 500 μm2 ) than MT+NB mice at 14 dpt. HB exposure after muscle trauma alone may prolong regeneration. Following HB exposure, therapies that promote oxygenation may be needed during this muscle recovery.

Hopes for healing: An exploratory study of trauma-informed care training and the juvenile justice system

The topic of traumatic stress among justice-involved youth has gained national attention. Studies have shown a multitude of factors contributing to youth experiencing trauma or victimization. Reports indicate that about 34% of children in the United States experience at least one traumatic event in their lives. Studies have shown that between 75% and 93% of youth in the juvenile justice system have suffered traumatic victimization of one form or another. In 2013, Texas passed legislation mandating all juvenile probation and juvenile supervision personnel to complete trauma-informed care training. A web-based Qualtrics survey, consisting of 28 items, was sent to Texas juvenile probation departments (JPD) with the goal to survey juvenile probation officers and other personnel, resulting in 108 responses. The study addressed (1) the type of trauma-care training received; (2) the implementation of trauma-focused practices and policies; and (3) the promotion of a physically and psychologically safe environment for justice-involved youth. The findings indicate that most of the respondents completed trauma-informed care training and met the state requirement. Although the training provided knowledge and understanding of youth trauma, not all juvenile probation officers referred youth to trauma-specific services, indicating a need for specific trauma-informed policies and practices with regular monitoring to ensure that youth received these rehabilitative services.

Study of initial blood lactate and delta lactate as early predictor of morbidity and mortality in trauma patients

ABSTRACT Background It has been demonstrated that lactate is a predictive indicator in trauma. It is yet unclear how non-normalization of lactate affects trauma victims. Methods In trauma patients, blood lactate levels were measured at admission and every 2 hours after that. A multivariate logistic regression analysis was conducted to identify the crucial variables to evaluate hospital mortality risk factors. Results 519 patients with trauma were assessed. Male patients (79%, n = 409) who were mostly young (42±20 years old) and had no comorbidities (ASA 1) made up the majority of the patient population. Patients who had normalization of serum lactate in the first 24 hours represented 76% (n = 392) of all trauma patients. Male patient status (OR = 2.2 (1.1–4.6)) and blood alcohol level (OR = 0.64 (0.44–0.91)) were independently linked in a logistic regression model with the failure of serum lactate to normalize in trauma patients over the initial 24 hours. Three variables were independently associated with hospital mortality: a GCS >9 (OR = 0.78(0.61–0.96)), and a pH> 7.37 (OR = 0.0028(0.00066–0.52)) at admission were protecting factors. One of the main risks for death in the pre-field was cardiorespiratory arrest (OR = 62 (2.2–4400)). Hospital mortality was not related to non-normalization of serum lactate in the initial 24 hours (OR = 1.8(0.4–7.9)). Conclusions Although serum lactate at admission is associated to trauma patient prognosis, our study failed to show that non-normalization of serum lactate in the initial 24 hours was a factor that could predict hospital mortality. A future study focusing on normalizing serum lactate in a shorter scale of time could be interesting.

Post‐translational modification and phenotype

Post‐translational modification and phenotype

Post-Traumatic Growth Following the Experience of Interpersonal Violence: The Roles of Perceived Stigma and Social Support

Post-Traumatic Growth is a term that refers to an individual's experience of considerable positive transformation following the occurrence of a traumatic event. This growth may be rapid, gradual, or non-existent, depending on the circumstances (such as social support or societal stigma) to which the victims are subjected during the process. However, the high prevalence of trauma among traumatized victims and the benefits of post-traumatic growth (PTG) discovered in increasing empirical research demonstrate the need of fostering PTG in victims of interpersonal violence. As a result, the current study analysed risk variables for PTG development. The study enrolled 200 women and men recruited through an organization that provides services to trauma victims. The data were gathered via an online survey that included the PTG inventory and an information sheet on demographic, social support, and stigma-related characteristics. Social stigma and support were found to be significant predictors of PTG, with stigma being associated with lower PTG and family and religious support being associated with higher PTG. The limitations and policy implications were highlighted, and recommendations for additional research were presented.

NURSING CARE TO TRAUMATIC BRAIN INJURY PATIENTS

Objective: This study aims to identify and evaluate the care provided by the nursing team, to learn more about the role of nurses in TBI, as well as their main care measures for the patient. Method: This is an integrative review of the last 9 years, of the following databases: Scielo, BVS, LILACS and Google Academic. Results: Traumatic Brain Injury better known by the acronym TBI is a pathology resulting from an aggression to the brain. Considered one of the main public health problems worldwide, traumatic brain injury is becoming increasingly more common in the modern world. It is fundamental that the care to the trauma victim be fast and efficient with trained health professionals, emphasizing that the nurse stands out for his peculiar attributes of care and organization of a diminished assistance. Conclusion: Knowledge about trauma kinematics and the physiopathology of TBI facilitates the care and handling of victims, in addition to minimizing the incidence of possible injuries or sequelae, making it essential to develop studies on the subject, so that nursing professionals are trained and perform their activities in an increasingly effective way.

Optimisation du transfert de planification de la distraction ostéogénique mandibulaire par dispositif externe sur mesure

The aim of this study was to analyze the predictability of virtual surgical planning of mandibular reconstruction by osteogenic distraction (OD) with a custom-made osteogenic distraction device (DEOS) after ballistic trauma and to make recommendations to mitigate potential sources of discrepancy. This retrospective study involved 12 patients who were victims of facial mandibular ballistic trauma and were reconstructed with osteogenic distraction with a DEOS device. Postoperative images were compared to the planned situation by means of several measures made in two plans: distraction plane and frontal plane. The mean bone loss was 54.2mm. The anteroposterior difference was systematically inferior or equal postoperatively (10.8mm). The interrami angle difference in the frontal plane was positive, with an average of 4.8°. There was a significant negative correlation in univariate analysis between the antero-posterior difference measurement and the difference of the interrami angle in distraction. A significant difference between the planning and postoperative results was shown, explained by the device being too adjustable leading to the loosening of the locking screws of the device. A static analysis showed that there are significant rotational forces at the carriages, which can lead to the loosening of the locking elements. It is then proposed that the device be optimized by customization of some elements.

Firearm Injury: An Escalating Health Crisis.

Firearm Injury: An Escalating Health Crisis.

Blood proteome of Acute Intracranial Hemorrhage in infant victims of Abusive Head Trauma.

Abusive head trauma (AHT) is a leading cause of mortality and morbidity in infants. While the reported incidence is close to 40 cases per 100'000 births/year, misdiagnoses are commonly observed in cases with atypical, subacute or chronic presentation. Currently, standard clinical evaluation of inflicted intracranial hemorrhagic injury (ICH) in infants urgently requires a screening test able to identify infants who need additional investigations. Blood biomarkers characteristic of AHT may assist in detecting these infants, improving prognosis through early medical care. To date, the application of innovative omics technologies in retrospective studies of AHT in infants is rare, due also to the blood serum and cerebrospinal fluid of AHT cases being scarce and not systematically accessible. Here, we explored the circulating blood proteomes of infants with severe AHT and their atraumatic controls. We discovered 165 circulating serum proteins that display differential changes in AHT cases compared with atraumatic controls. The peripheral blood proteomes of pediatric AHT commonly reflect: i) potentially secreted proteome from injured brain, and ii) proteome dysregulated in the system's circulation by successive biological events following acute ICH. This study opens up a novel opportunity for research efforts in clinical screening of AHT cases. This article is protected by copyright. All rights reserved.

In Their Own Words: Women Veterans Identify the Personal Consequences of Military Sexual Trauma Victimization.

This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.

Demographics and Patterns of Injury in Patients with Sharp Penetrating Trauma admitted to a Greater Manchester Major Trauma Centre: A Retrospective Five-Year Study

Background: Sharp penetrating trauma represents 4.1%-6.9% of all major trauma cases in the UK. The incidence of Sharp penetrating trauma is rising, with 47,000 offences in England and Wales in 2019. There has been limited published data on the victims of sharp penetrating trauma. Methods: We performed a single centre retrospective case note review of patients admitted to an urban major trauma centre following an assault with a sharp object from 1st January 2014 to the 31st December 2018. Data was collected on demographics, injury pattern, management, and outcome. Results: In total, 686 patients were included in the study. There was a year-on-year increase of admissions with sharp penetrating trauma from 100 admissions in 2014, to 194 in 2018. The majority of patients were male, with a mean age of 31, and 73% of our patients were of Caucasian ethnicity. Patients presented most frequently on weekends (53%). The length of stay increased over the study period from 2.3 days in 2014 to 4.0 days in 2018. The thorax was the most commonly injured body region, involved in 29% of presentations, followed by the abdomino-pelvis (21%). 51% of patients presented with multiple injuries, and the average number of stab wounds per patient increased from 1.95 in 2014 to 2.40 in 2018. Conclusion: Our study has demonstrated the incidence and severity of sharp penetrating trauma is increasing in central Manchester. The authors advocate the creation of a national knife crime database to further the implementation of prevention strategies.

Pattern and Severity of Traumatic Renal Injury: A Three-Year Study at Single Level One Trauma Center in Southern Iran

Background: Renal trauma is among the most important trauma challenges. Better management of traumatic renal patients is necessary to improve the patients’ clinical outcome. Objectives: This study aimed to analyze the pattern, severity, mechanism of injury, and outcome in renal trauma. Methods: This cross-sectional study was conducted in the largest trauma center in southern Iran from March 2018 to June 2022. Adult patients with diagnosed renal trauma based on abbreviated injury scale guideline were included. Variables of age, gender, anatomy of injury, mechanism of injury, lenghth of hospitalization, level of blood pressure, severity of injury, and the outcome of patients have been collected. Results: In total, 4,416 traumatic patients were admitted to the Emergency Department of the Hospital during the study time, of which 46 cases had traumatic renal injury. The rate of renal injury in the level one trauma center in southern Iran was 0.96%, and the death rate in renal injury victims was 12(26.1%). Most of the injured with renal injury were men 39(84.8%). Blunt trauma was the dominant type of trauma in most victims with renal injury 34(73.9%). Thirty-seven percent (n=17) of traumatic renal injury victim was in mild level (grade 1 and 2), and 16(34.8%) in severe level (grade 4 and 5). Renal injury was mostly associated with thorax injury (n=46) as extra-abdominal organ injury, and liver injury (n=16) and spleen (n=15) as intra-abdominal organ injury. Conclusion: The results of the present study showed that the severity of injury in patients with renal injury is high, and it is usually associated by injury to other body organs. It is suggested that the traumatic patients should be immediately examined for renal injury in the resuscitation department due to the high mortality rate and severity of these patients.

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

thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can be superficial or immediately lifethreatening for victims. In Brazil, most assistance is due to urban violence. evaluate the clinical and epidemiological aspect of patients who are victims of thoracic trauma treated at Hospital de Urgência de Sergipe, Aracaju/SE, Brazil. cross-sectional, observational and prospective study, carried out for eleven months, with 100 polytraumatized patients. A semi-structured form was applied, and the data were systematized, analyzed and statistically tested considering a 5% margin of error. Results: 85% of the patients were male, with a mean age of 39.3 and an age range of 30 to 49 years; 57% of them had incomplete primary education, 70% had a family income of up to 2 minimum wages and 41% were from Greater Aracaju. As for the mechanism of trauma, 33% were car-related, with blunt trauma as the main mechanism, and rib fractures as the main consequence. Among penetrating injuries, CWI (26%) and GSW (21%) were the most prevalent, with hemothorax being the main consequence. Most patients underwent thoracostomy (59%). the profile found was of young men, victims of urban violence. The thoracostomy was resolving in most cases and should be instituted promptly when necessary. A smaller number of patients may require thoracotomy, especially in the presence of hemodynamic instability.

Families and Friends of Homicide Victims' Experiences With the Healthcare System: A Trauma-Informed Perspective.

Families and friends of homicide victims (FFHV) interact with healthcare systems almost immediately after the traumatic event. Their interactions with healthcare providers can either facilitate healing, have a neutral effect, or compound an already painful experience. When trauma victims are admitted to the hospital, resources are necessarily diverted on their behalf with less consistent attention paid to their families and friends. The interactions surrounding the immediate circumstance as well as experiences in the weeks to months after can have significant long-term impact. This study explores the needs and experiences of FFHV when interacting with the healthcare system to inform physicians' and providers' interactions and provision of services. This study of 3 focus groups sought to understand these experiences with the healthcare system to better inform physicians' and providers' interactions and provision of services. Using the framework approach, the study ultimately built upon the existing trauma-informed care (TIC) framework to include several emergent themes. Participants discussed the need for death notification sensitivity, benefits of coordinated care, barriers to accessing care, the need for physician empathy and attention, the lack of trauma screening, and hastily prescribing medications. This TIC approach can inform future healthcare interactions with the FFHV as it grounds the patients' experience in their historical reality and may improve future provider-patient relationship.