Survivors Of Traumatic Injury Research Articles

Pharmacotherapy to prevent PTSD: Results from a randomized controlled proof‐of‐concept trial in physically injured patients

Acute physical injury is frequently associated with mental health sequelae, which then accentuate disability and worsen functional outcomes. A pharmacological prevention approach to this problem has been proposed. This proof-of-concept study was a double-blind, randomized controlled trial of 14 days of the beta-blocker propranolol (n = 17), the anxiolytic anticonvulsant gabapentin (n = 14), or placebo (n = 17), administered within 48 hours of injury to patients admitted to a surgical trauma center. Of 569 accessible, potentially eligible subjects, 48 (8%) participated. Outcomes assessments were conducted at 1, 4, and 8 months postinjury. Although well tolerated, neither study drug showed a significant benefit over placebo on depressive or posttraumatic stress symptoms. Implications are discussed for future pharmacological prevention studies in survivors of acute traumatic injury.

Behavioral Activation as an Early Intervention for Posttraumatic Stress Disorder and Depression Among Physically Injured Trauma Survivors

This paper describes an adaptation of behavioral activation (BA) for the early intervention of posttraumatic stress disorder (PTSD) and depression among physically injured survivors of traumatic injury, and presents pilot data on a small randomized effectiveness trial ( N = 8). The application of BA to PTSD is based on the theory that increases in guided activity may break patterns of avoidance that can maintain PTSD. Compared to treatment as usual (TAU), those who received BA showed improvement in PTSD symptom severity from pre- to posttreatment, and there was a trend for the BA group to score better than the TAU group on physical functioning. Contrary to expectation, this brief adaptation did not have an impact on depression. Implications of these results for the effective early intervention after trauma are discussed.

Rat Models of Traumatic Spinal Cord Injury to Assess Motor Recovery

Devastating motor, sensory, and autonomic dysfunctions render long-term personal hardships to the survivors of traumatic spinal cord injury (SCI). The suffering also extends to the survivors' families and friends, who endure emotional, physical, and financial burdens in providing for necessary surgeries, care, and rehabilitation. After the primary mechanical SCI, there is a complex secondary injury cascade that leads to the progressive death of otherwise potentially viable axons and cells and that impairs endogenous recovery processes. Investigations of possible cures and of ways to alleviate the hardships of traumatic SCI include those of interventions that attenuate or overcome the secondary injury cascade, enhance the endogenous repair mechanisms, regenerate axons, replace lost cells, and rehabilitate. These investigations have led to the creation of laboratory animal models of the different types of traumatic human SCI and components of the secondary injury cascade. However, no particular model completely addresses all aspects of traumatic SCI. In this article, we describe adult rat SCI models and the motor, and in some cases sensory and autonomic, deficits that each produces. Importantly, as researchers in this area move toward clinical trials to alleviate the hardships of traumatic SCI, there is a need for standardized small and large animal SCI models as well as quantitative behavioral and electrophysiological assessments of their outcomes so that investigators testing various interventions can directly compare their results and correlate them with the molecular, biochemical, and histological alterations.

Changes over time in cognitive and structural profiles of head injury survivors

Survivors of traumatic head injury often suffer chronic cognitive deficits. Considerable evidence implicates the cholinergic system in these deficits. Recently, we reported cognitive and structural abnormalities in a cohort of head injured survivors consistent with this hypothesis [see Salmond, C. H., Chatfield, D. A., Menon, D. K., Pickard, J. D., & Sahakian, B. J. (2005). Cognitive Sequelae of Head Injury: Involvement of Basal Forebrain and associated structures. Brain, 128(1), 189–200]. The stability of the cognitive and structural MRI profiles was investigated in a longitudinal study. Twenty-one survivors of moderate–severe head injury completed two comprehensive neuropsychological assessments and two structural MRI scans at least six months apart. A cohort of controls also completed these investigations. The results revealed that the cognitive and structural profiles are relatively stable from six months post-injury forward up to 3 years post-injury. Deficits in memory, attention and reaction time were found, with relative preservation of working memory, consistent with abnormalities in the cholinergic system. These findings suggest that cholinergic enhancers may be an effective treatment for cognitive deficits post-head injury in survivors up to three years post-injury.

Modelling 5-year functional outcome in a major traumatic injury survivor cohort

Aim. To estimate associations between possible predictors of functional disability outcome at 5 years in a working adult population cohort of survivors of major traumatic injury and to develop a prognostic model of outcome.Design. Population based retrospective cohort study.Population. Persons who had experienced major traumatic injury (Injury Seventy Score >15) in the area of the former Yorkshire Regional Health Authority during the period 30 September 1988 to 1 October 1989 and who survived for 5 years (average 5.3 years).Methods. The same interviewer saw each survivor at their home and used the OPCS Adult Disability Schedule to ascertain levels of functional disability. Disability scores for each survivor were then combined in accordance with the OPCS guidance to calculate a level of disability between 0 (no disability) to 10 (maximum disability). The OPCS level was then dichotomised with a cut-point at 4/5. Possible predictor and confounding variables from pre-injury, injury and post-injury periods were modelled in a logistic regression to identify those that predicted outcome level. Two reduced models were developed to allow early prognosis of late outcome.Results. The full model correctly classified 91% of observed outcomes. Inpatient length of stay OR 1.031 (95% CI 1.014,1.048) per day predicted poorer 5-year outcome; Glasgow Coma Score OR 0.790(0.629,0.992) per 1 point increase; stay in Intensive Care Unit OR 0.931 (0.877,0.987) per day; attainment of degree-level education OR 0.014 (0.000,0.707); single civil status OR 0.110 (0.013,0.908); being taken initially to a hospital with a neurosurgical facility OR 0.064(0.010,0.420); being in paid work during the 2 weeks before index injury OR 0.093(0.009,0.969) predicted better 5-year disability outcome. Two reduced models were constructed that included a simple set of variables, one of these models excluded any rehabilitation variables but still correctly classified 85% of the observed outcomes.Conclusion. As well as level of traumatic brain injury (TBI) and total inpatient stay, Pre-injury educational attainment and employment, civil status, immediate care in a hospital with a neurosurgical facility and stay in an Intensive Care Unit determined 5-year outcome. It is possible to efficiently predict outcome at an early stage. Previous work on predictors of disablement have suffered from large selection and attrition biases.

Delayed-onset PTSD: A prospective study of injury survivors

Background Recent studies have indicated that delayed-onset posttraumatic stress disorder (PTSD) (i.e., the development of PTSD more than 6 months posttrauma) is generally characterised by subsyndromal diagnoses within the first 6 months. This study sought to examine the relationship between sub-clinical levels of PTSD symptoms at 3 months posttrauma and delayed onset PTSD at 12 months in a large sample of traumatic injury survivors. Methods Three hundred and one consecutively admitted injury survivors were assessed at 3 and 12 months posttrauma. PTSD was diagnosed according to DSM-IV criteria, while partial and subsyndromal diagnoses were based on recent definitions developed by Mylle and Maes [Mylle, J., Maes, M., 2004. Partial posttraumatic stress disorder revisited. J. Affect. Disord. 78, 37–48]. Results Eight percent of participants was diagnosed with 3-month PTSD while 10% was diagnosed with 12-month PTSD. Nearly half (47%) of 12-month PTSD cases were of delayed onset. The majority of those with delayed-onset were diagnosed with partial or subsyndromal PTSD at 3 months. Ten percent of delayed onset cases did not meet partial or subsyndromal criteria. Limitations As symptoms were not assessed at 6 months (the DSM cut-off for delayed PTSD), it could not be conclusively determined that delayed-onset cases had not developed PTSD between 3 and 6 months posttrauma. Conclusion A considerable proportion of 12-month PTSD diagnoses was delayed in onset. While most demonstrated 3-month morbidity in the form of partial and subsyndromal diagnoses, a minority did not. Thus, clinicians should consider subthreshold diagnoses as potential risk factors for delayed-onset PTSD. Future research is required to identify factors that may predict delayed-onset PTSD in trauma survivors without evidence of prior PTSD pathology.

Patients' views on outcome following head injury: a qualitative study

BackgroundHead injuries are a common occurrence, with continuing care in the years following injury being provided by primary care teams and a variety of speciality services. The literature on outcome currently reflects areas considered important by health-care professionals, though these may differ in some respects from the views of head injured individuals themselves. Our study aimed to identify aspects of outcome considered important by survivors of traumatic head injury.MethodsThirty-two individuals were interviewed, each of whom had suffered head injury between one and ten years previously from which they still had residual difficulties. Purposive sampling was used in order to ensure that views were represented from individuals of differing age, gender and level of disability. These interviews were fully transcribed and analysed qualitatively by a psychologist, a sociologist and a psychiatrist with regular meetings to discuss the coding.ResultsAspects of outcome mentioned by head injury survivors which have received less attention previously included: specific difficulties with group conversations; changes in physical appearance due to scarring or weight change; a sense of loss for the life and sense of self that they had before the injury; and negative reactions of others, often due to lack of understanding of the consequences of injury amongst both family and general public.ConclusionSome aspects of outcome viewed as important by survivors of head injury may be overlooked by health professionals. Consideration of these areas of outcome and the development of suitable interventions should help to improve functional outcome for patients.

Premorbid intelligence and brain injury

To determine whether NART scores are associated with severity of brain injury and therefore presumably affected by brain injury. In addition, to compare the Cambridge Contextual Reading Test (CCRT) with injury severity in head-injured individuals. Participants were 55 survivors of traumatic head injury, who completed the NART and the CCRT. The scores on these premorbid measures were then compared with indices of injury severity from their initial neurosurgical admission. The NART was significantly correlated with Glasgow coma scale, with greater severity of injury associated with poorer performance. Poorer NART performance was also significantly more likely amongst those whose injury resulted in coma. The CCRT was preferred by patients, though it was also significantly associated with Glasgow coma scale and presence of coma. The data suggest that performance on both the NART and the CCRT are affected by brain injury severity and thus may underestimate true premorbid ability in these individuals. Similar findings would be likely with the conceptually identical WTAR measure. These measures should be used with appropriate caution and may be usefully supplemented by predictions based on demographic information.

33. Traffic Injury Prevention Program

In Texas (1999), teen crashes accounted for 76% of all teen deaths caused by unintentional injuries. More than 20% of persons injured in a motor vehicle–related event were between the ages of 15 and 24 years old. The purpose of this project is to reduce the incidence of teen motor vehicle–related crashes by providing an injury prevention field trip program to teens (TIPP). Prehospital, hospital, and law enforcement are core components of the program. The message is proactive and positive in addressing driving safely and being aware of the lifetime impact of driving under the influence–related motor vehicle crashes. Students receive a teen drinking/driving crash scenario with hands-on education from EMS and the Fire Department in the extrication/resuscitation of victims from a wrecked vehicle. The participants escort “patients” to the trauma rooms for the resuscitation. The resuscitation is conducted in “real-life” simulation with nurses and physicians describing the patient's injuries and treatment. The patient is taken to the burn unit where students learn about the burn treatment requirements. Physical appearance is significant to teens and this portion of the program gives impact on self-perception. To learn the long-term effects of drinking and driving, participants hear from physical therapists about the treatment of spinal cord injuries and other debilitating injuries. The day ends with an open discussion that is shared with survivors of traumatic injuries whose lives were impacted as a result. The theory behind TIPP is that by exposing teens to a traumatic scenario, the imprint of the sights, sounds, and the odors are recorded in the teen's experience and can become powerful stimuli (toward injury prevention and behavioral change) in the future. TIPP has been presented 15 times to approximately 1000 students. A pretest, posttest, and evaluation tool is administered. The subjects tested were between the ages of 16 and 18 years. Subjects (95%) scored less than 100% on the pretest. However, these same subjects scored above 95% on the posttest, demonstrating increased comprehension of the dangers of drinking and driving. The evaluation tools reveal that students were affected with “real-life” hands-on participation in the resuscitation of crash victims and by the “real-life” discussions with survivors who sustained (preventable) injuries. A multidisciplinary and collaborative effort from different agencies is recommended, that is, hospital, prehospital, fire, and police. The main challenge for this program's success is in obtaining adequate funding for work force to track, evaluate, and measure the outcomes.

The epidemiology of disability and occupation handicap resulting from major traumatic injury

Purpose: To assess the prevalence of disability and handicap among survivors of major traumatic injury (injury severity > score 15) using a prospective population based cohort study design. The study was set in the former Yorkshire Health Region. Subjects/Methods: A cohort of 367 individuals identified as having received and survived major traumatic injury during the 12 month period October 1988-September 1989. OPCS disability scores and employment status at 5 years post injury were established through structured face-to-face interviews. Results: Three hundred and four (84% response, 89% adjusted response) individuals were interviewed. Seventy-seven percent of these were male and they had a mean age (SEM) of 30.8 (1.06) years. Injuries were caused by road traffic accidents in 68% of the cases and were primarily orthopaedic and neurological in nature. At 5 years post injury 81.2% of individuals had some form of measurable disability principally relating to locomotion, behaviour, continence and intellectual functioning consistent with injury type. A third had an OPCS disability score of 5 or greater and approximately 1 in 12 were in the most severe categories of OPCS scores of 9-10 necessitating dependency on formal or informal carer assistance. Whilst five of the eight sub-scales of the SF36 showed correlation in severity proportion, general health perception and energy/vitality were higher in those with increasing disability as measured by the OPCS scale. Of those between the ages of 16-64 nearly half (49%) were not in paid employment at the time of follow up. Conclusion: A high prevalence of severe permanent disability, work disability and occupation handicap has been identified in a cohort of mainly young adult males following major traumatic injury resulting from road traffic accidents. Progress in accident prevention, injury reduction and the management of patients with serious injuries should be measured not only in terms of reduced mortality from such events but also in the long term disability and quality of life sequelea of survivors.

The prevalence of disability among survivors of major traumatic injury

The prevalence of disability among survivors of major traumatic injury

Uncontrolled pain following physical injury as the core-trauma in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric diagnostic category characterized by “the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience”. Research shows that the prevalence of PTSD among injured survivors of stressful events is higher than that of survivors without physical injury, thus suggesting that secondary Stressors (e.g., severe uncontrolled pain, a prolonged state of acute anxiety, uncertainty regarding the immediate future, loss of control, and inability to monitor contact with the environment) may play an important role in the formation of PTSD. However, pain has never been suggested or recognized as a direct cause of PTSD. We present the case of a patient who lost an eye under traumatic circumstances and was later diagnosed as suffering from PTSD. Upon evaluation in a psychophysiological laboratory, this patient's core-trauma was discovered to be 7 h of severe uncontrolled pain while waiting for surgery, rather than the moment when he lost his eye during military service. The case suggests that pain, although not “generally outside the range of usual human experience”, may be a strong enough Stressor in traumatic circumstances to cause the development of PTSD, thus highlighting the importance of prompt and adequate pain management in hospitalized survivors of traumatic injury.

Development of an instrument to assess personality changes in survivors of traumatic head injury

Development of an instrument to assess personality changes in survivors of traumatic head injury

Development of an instrument to assess personality changes in survivors of traumatic head injury

Development of an instrument to assess personality changes in survivors of traumatic head injury

Head injuries--what happens to survivors.

The head injury syndrome is a series of psychological characteristics observed in survivors of traumatic head injuries referred to a hospital-based rehabilitation centre. Severe cases of head injury syndrome are readily identifiable as cases of organic dementia. In less florid cases patients easily pass for normal in routine consultation situations, but upon expert psychometric assessment, elements of the head injury syndrome can be demonstrated. Such patients exhibit a high propensity to fail to live up to the normal expectations of their work and domestic environment, and suffer repeated failures and social difficulties which are the direct result of the head injury syndrome. This leads to breakdown of work and family life, increasing frustration, loss of confidence, and final disintegration of the affected personality.