Journal of Trauma Nursing最新文献

{"title":"Sanguine.","authors":"Emilie S Gardner","doi":"10.1097/JTN.0000000000000717","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000717","url":null,"abstract":"","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9421986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Serial Phlebotomy in the Management of Blunt Solid Organ Injury in Adults.","authors":"Mohammad A Frotan,&nbsp;Philip Edmundson,&nbsp;Christopher Cooper,&nbsp;Brian Tibbs,&nbsp;Laura Garlow,&nbsp;Kaeli Vandertulip,&nbsp;Amy Miller,&nbsp;Subhash Aryal,&nbsp;Jacob W Roden-Foreman,&nbsp;G Tom Shires","doi":"10.1097/JTN.0000000000000718","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000718","url":null,"abstract":"<p><strong>Background: </strong>The management of blunt spleen and liver trauma has become increasingly nonoperative. There is no consensus on timing or duration of serial hemoglobin and hematocrit monitoring in this patient population.</p><p><strong>Objective: </strong>This study examined the clinical utility of serial hemoglobin and hematocrit monitoring. We hypothesized that most interventions occur early in the hospital course, based on hemodynamic instability or physical examination findings rather than serial monitoring.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult trauma patients with blunt spleen or liver injury from November 2014 through June 2019 at our Level II trauma center. Interventions were classified as no intervention, surgical intervention, angioembolization, or packed red blood cell transfusion. Demographics, length of stay, total blood draws, laboratory values, and clinical triggers preceding intervention were reviewed.</p><p><strong>Results: </strong>A total of 143 patients were studied, of whom 73 (51%) received no intervention, 47 (33%) received an intervention within 4 hr of presentation, and 23 (16%) had interventions beyond 4 hr. Of these 23 patients, 13 received an intervention based on phlebotomy results alone. Most of these patients (n = 12, 92%) received blood transfusion without further intervention. Only one patient underwent operative intervention based on serial hemoglobin results on hospital day 2.</p><p><strong>Conclusion: </strong>The majority of patients with these injury patterns either require no intervention or declare themselves promptly after arrival. Serial phlebotomy after initial triage and intervention may add little value in the management of blunt solid organ injury.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9424536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Complicated Mild Traumatic Brain Injury in Adolescent Trauma to Enhance Clinical Decisions in Imaging.","authors":"Heather X Rhodes,&nbsp;Gina Berg,&nbsp;Anthony L Shadiack,&nbsp;Kevin D Thomas,&nbsp;Jennifer L Horawski,&nbsp;Geoff Boyer,&nbsp;Sara M Kleist,&nbsp;Aaron I Worthley,&nbsp;David I Rosenberg,&nbsp;Scott B Gutovitz,&nbsp;George A Helmrich,&nbsp;Saptarshi Biswas,&nbsp;Antonio P Pepe","doi":"10.1097/JTN.0000000000000720","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000720","url":null,"abstract":"<p><strong>Background: </strong>The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy.</p><p><strong>Objective: </strong>This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10-15 years), Glasgow Coma Scale (13-15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN.</p><p><strong>Results: </strong>There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury.</p><p><strong>Conclusions: </strong>We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9424539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Passages.","authors":"Amy E Krichten","doi":"10.1097/JTN.0000000000000716","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000716","url":null,"abstract":"","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9421987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Seniors at Risk Score to Determine Geriatric Evaluations on Trauma Patients With Hip Fractures.","authors":"Taylor K Long,&nbsp;Stephanie D Booza,&nbsp;Lauren N Turner","doi":"10.1097/JTN.0000000000000719","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000719","url":null,"abstract":"<p><strong>Background: </strong>Trauma centers are confronted with rising numbers of geriatric trauma patients at high risk for adverse outcomes. Geriatric screening is advocated but not standardized within trauma centers.</p><p><strong>Objective: </strong>This study aims to describe the impact of Identification of Seniors at Risk (ISAR) screening on patient outcomes and geriatric evaluations.</p><p><strong>Methods: </strong>This study used a pre-/postdesign to assess the impact of ISAR screening on patient outcomes and geriatric evaluations in trauma patients 60 years and older, comparing the periods before (2014-2016) and after (2017-2019) screening implementation.</p><p><strong>Results: </strong>Charts for 1,142 patients were reviewed. Comparing pre- to post-ISAR groups, the post-ISAR group with geriatric evaluations were older (M = 82.06, SD = 9.51 vs. M = 83.64, SD = 8.69; p = .026) with higher Injury Severity Scores (M = 9.22, SD = 0.69 vs. M = 9.38, SD = 0.92; p = .001). There was no significant difference in length of stay, intensive care unit length of stay, readmission rate, hospice consults, or inhospital mortality. Inhospital mortality (n = 8/380, 2.11% vs. n = 4/434, 0.92%) and length of stay in hours (M = 136.49, SD = 67.09 vs. M = 132.53, SD = 69.06) down-trended in the postgroup with geriatric evaluation.</p><p><strong>Conclusion: </strong>Resources and care coordination efforts can be directed toward specific geriatric screening scores to achieve optimal outcomes. Varying results were found related to outcomes of geriatric evaluations prompting future research.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9424535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effect of a Dosing and Titration Protocol on Dexmedetomidine-Induced Hypotension in Trauma Patients.","authors":"Peyton M Kurtz,&nbsp;Jason VanLandingham,&nbsp;Michael Cormican,&nbsp;Kyle Gibson,&nbsp;Leslie Roebuck","doi":"10.1097/JTN.0000000000000721","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000721","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine is an α-2 receptor agonist commonly used as a continuous infusion for sedation and analgesia; however, dose-dependent hypotension may limit its utility. Despite its widespread use, there is no consensus on appropriate dosing and titration.</p><p><strong>Objective: </strong>The objective of this study was to determine whether a dexmedetomidine dosing and titration protocol is associated with decreased rates of hypotension in trauma patients.</p><p><strong>Methods: </strong>This pre-post intervention study took place at a Level II trauma center in the Southeastern United States from August 2021 to March 2022 and included patients admitted by the trauma service to either the surgical trauma intensive care unit or intermediate care unit and received dexmedetomidine for greater than or equal to 6 hours. Patients were excluded if they were hypotensive or on vasopressors at baseline. The primary outcome was incidence of hypotension. Secondary outcomes included dosing and titration practices, initiation of a vasopressor, incidence of bradycardia, and time to goal Richmond Agitation Sedation Scale (RASS) score.</p><p><strong>Results: </strong>Fifty-nine patients met inclusion criteria: 30 in the pre-intervention group and 29 in the post-intervention group. Protocol adherence in the post group was 34% with a median of one violation per patient. Rates of hypotension were similar between the groups (60% vs. 45%, p = .243) but significantly lower in the post group patients with zero protocol violations (60% vs. 20%, p = .029). The post group also had a significantly lower maximal dose (1.1 vs. 0.7 μg/kg/hr, p < .001). There were no significant differences in the initiation of a vasopressor, incidence of bradycardia, or time to goal RASS.</p><p><strong>Conclusion: </strong>Adherence to a dexmedetomidine dosing and titration protocol significantly decreased incidence of hypotension and maximal dexmedetomidine dose without increasing time to goal RASS score in critically ill trauma patients.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9424540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effect of a Dosing and Titration Protocol on Dexmedetomidine-Induced Hypotension in Trauma Patients.","authors":"","doi":"10.1097/JTN.0000000000000727","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000727","url":null,"abstract":"","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9421989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ATTAC! Development of a Novel Advanced Trauma Team Application Course.","authors":"Lanny Orr,&nbsp;Lisa Stevens,&nbsp;Elizabeth McCotter,&nbsp;Alexa Peterson,&nbsp;Jeannine M Brant,&nbsp;Simon J Thompson","doi":"10.1097/JTN.0000000000000711","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000711","url":null,"abstract":"<p><strong>Background: </strong>Although existing trauma nurse courses provide basic education, advanced courses with simulation experiences that enhance team leadership, communication, and workflows are lacking.</p><p><strong>Objective: </strong>To design and implement the Advanced Trauma Team Application Course (ATTAC) to promote advanced skills for nurses and respiratory therapists with varied experience and skill levels.</p><p><strong>Methods: </strong>Trauma nurses and respiratory therapists were selected to participate based on years of experience and the novice to expert nurse model. Two nurses from each level (excluding novice) participated, ensuring a diverse cohort to promote development and mentorship. The 11-module course was presented over 12 months. A five-question survey was employed at the end of each module to self-evaluate assessment skills, communication skills, and comfort for trauma patient care. Participants rated skills and comfort on a \"0-10\" scale, with 0 being \"not at all\" to 10 being \"extensively.\"</p><p><strong>Results: </strong>The pilot course was conducted from May 2019 to May 2020 at a Level II trauma center in the Northwest United States. Nurses reported ATTAC improved assessment skills, team communication, and comfort in caring for trauma patients (mean = 9.4; 95% CI [9.0, 9.8]; scale of 0-10). Participants indicated scenarios closely mimicked real-world situations; concept application commenced directly following each session.</p><p><strong>Conclusion: </strong>This novel approach to advanced trauma education promotes development of advanced skills that enable nurses to anticipate needs rather than being reactive, engage in critical thinking, and adapt to rapidly changing patient conditions.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury: Iterative Development of an Audit Tool for Trauma Patients.","authors":"Andrew Holt,&nbsp;Jordan Rahm,&nbsp;H Andrew Hopper,&nbsp;Darrell L Hunt","doi":"10.1097/JTN.0000000000000710","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000710","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury is a low-volume, high-risk complication in trauma patients and is associated with prolonged hospital length of stay and increased mortality. Yet, no audit tools exist to evaluate acute kidney injury in trauma patients.</p><p><strong>Objective: </strong>This study aimed to describe the iterative development of an audit tool to evaluate acute kidney injury following trauma.</p><p><strong>Methods: </strong>Our performance improvement nurses developed an audit tool to evaluate acute kidney injury in trauma patients using an iterative, multiphase process conducted from 2017 to 2021, which included a review of our Trauma Quality Improvement Program data, trauma registry data, literature review, multidisciplinary consensus approach, retrospective and concurrent review, and continuous audit and feedback for piloted and finalized versions of the tool.</p><p><strong>Results: </strong>The final acute kidney injury audit tool can be completed within 30 min using data obtained from the electronic medical record and consists of six sections, including identification criteria, source potential causes, source treatment, acute kidney injury treatment, dialysis indications, and outcome status.</p><p><strong>Conclusion: </strong>The iterative development and testing of an acute kidney injury audit tool improved the uniform data collection, documentation, audit, and feedback of best practices to positively impact patient outcomes.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Animal-Assisted Therapy in Treatment of Patients With Traumatic Brain Injury: A Randomized Trial.","authors":"Leslie Horton,&nbsp;Margaret Griffen,&nbsp;Lui Chang,&nbsp;Anna B Newcomb","doi":"10.1097/JTN.0000000000000705","DOIUrl":"https://doi.org/10.1097/JTN.0000000000000705","url":null,"abstract":"<p><strong>Background: </strong>Severe traumatic brain injury carries major public health consequences, with patients suffering long-term disability with physiological, cognitive, and behavioral changes. Animal-assisted therapy, the use of human and animal bonds in goal-directed interventions, has been a suggested therapy, but its efficacy in acute brain injury outcomes remains unknown.</p><p><strong>Objective: </strong>This study aimed to assess animal-assisted therapy's effects on cognitive outcome scores of hospitalized severe traumatic brain-injured patients.</p><p><strong>Methods: </strong>This single-center, randomized, prospective trial was conducted from 2017 to 2019 and examined the effects of canine animal-assisted therapy on the Glasgow Coma Scale, Rancho Los Amigo Scale, and Levels of Command of adult severe traumatic brain-injured patients. Patients were randomized to receive animal-assisted therapy or usual standard of care. Nonparametric Wilcoxon rank sum tests were used to study group differences.</p><p><strong>Results: </strong>Study patients (N = 70) received 151 sessions with a hander and dog (intervention, n = 38) and 156 without (control, n = 32) from a total of 25 dogs and nine handlers. When comparing the patients' response during hospitalization to animal-assisted therapy versus control, we controlled for sex, age, baseline Injury Severity Score, and corresponding enrollment score. Although there was no significant change in Glasgow Coma Score (p = .155), patients in the animal-assisted therapy group reported significantly higher standardized change in Rancho Los Amigo Scale (p = .026) and change commands (p < .001) compared with the control group.</p><p><strong>Conclusions: </strong>Patients with traumatic brain injury receiving canine-assisted therapy demonstrated significant improvement compared with a control group.</p>","PeriodicalId":51329,"journal":{"name":"Journal of Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10029142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}